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4C ND Geological Audit Services Inc. I ( � uCHAIN OF CUSTOD CORD <br /> 9 <br /> Dat Page- (_ �of <br /> vaw <br /> -- <br /> PROJECT MANAGER <br /> Client <br /> C✓�_ f? .3604-1t� %% PHONE NUMBER <br /> 0130 <br /> PROJECT NAME SAMPLE S (Signature) <br /> SAMPLE TYPE <br /> SAMPLE LOCATION DATE TIME WATER AIR SOLID NO OF TESTS <br /> NUMBER DESCRIPTION CompGrab CNTNRS REQUIRED <br /> 64 L uFT A, DTE f 770#- <br /> C <br /> r / <br /> Rel quI ed by { gnalure) R iv by (Srgnatur ) DalelTime <br /> ..� <br /> to Pk- <br /> Relinquished by (Signature) ved by (Signalure) DatelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for meld analysis <br /> Date/Time <br /> (Signature) <br /> Dispatched by(Signature) Date/Time Received lot Laboratory by Dale/Time <br /> Method of Shipment I hereby authorize the performance of the above indicated work <br /> Special instructions <br /> COM'50517-25 &-L <br /> SOURCE Adapled Item US EPA 1985 CCH 100 <br />