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- Geological Audit Services, Inc. CHAIN OF CUSTODY RECORD <br /> Date j �� / Page_ �of� <br /> �lC�c.. --. f PROJECT MANAGER -- <br /> Client V1 C.to F e r Ve Y) <br /> PHONE NUMBER <br /> PROJECT NAME 1V;C), G V y [ /SAMPLERS (Signature) <br /> ry <br /> SAMPLE TYO= <br /> t <br /> SAMPLE LOCATION ( DATE TIME WATER 4AIR SOLID NO OF TESTS <br /> NUMBER DESCRIPTION Comp Grab CNTNRS REQUIRED <br /> Sty - ICS- z +i btlWAY -10 -5/ H - gr e,,- e,V 7AT <br /> �a <br /> 1 <br /> Relinquishedby (Signature) Received by (Signalure) DatelTrme <br /> Re I firr4shed by (Signature) Received by ISrgnaturel ! Date/Time <br /> Relinquished by (Signature) Received by Mobile Labaratorti fo, 'reld analysis DatelTrme <br /> ,Signature) <br /> Dispatched by(Signature) Date/Time Received lo, Laboratory by DatelTime <br /> Method of Shipment i reby authorize the performance of the above indicated work <br /> �uJr�c�� <br /> Special Instructions <br /> SOURCE Aa apt ea[torn U S EPA 1985 TL 9(43 GGA VD <br />