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Geological Audit Services , AIN of CUSTODY REC0n[> <br /> ery � Inc .l n � ,vie 3r%`�_���j Page I of <br /> '" — crn�i�tx(menta Pro/�sst�ra�r-�- <br /> 1fi0J West March Lane, Suite A- Stockton, CaliforniaCalitorrtia-95207•(209)958.02131 <br /> Clienta u 5 s <br /> j c L q lllwU dj 6 „-,d y l l Ccs Project Manager <br /> - Ke-Vw1 �! �t'� 3 1�r Tests Required <br /> Phone Number / <br /> Samplers: (Signature) � - ,�r � � <br /> Invoice: <br /> Project Name ]�i{ [ C c1.� I`1 o i c1; _ ,+ C f vc 14 d / GeoAudit ❑ <br /> Sample Location Sample Type <br /> - C <br /> lient <br /> WatertrNumber Description Date TiSolidFCo <br /> CompGrab. Air tosf Notes <br /> ; <br /> r 1 j <br /> 34865 <br /> t k <br /> a+ngwshe by: ( ignature) <br /> ? ece+ve y; +gnatura} <br /> Relinquished by: (Signature) Re y: {Signature) <br /> Date(Time <br /> Relinquished by: (Signatures <br /> ceived by Mobile Laboratory for field analysis: (Signature) <br /> 0 te(Time <br /> Dispatched by: (Signature) Date(Time Received for Laboratory by: <br /> DatelTime <br /> Method of Shipment: <br /> Laboratory Name <br /> Special Instructions: <br /> Ic L7�C�+CCapr7Ty + i f hereby authorize Iha performance of the above indicated work, <br /> GOOD <br /> #-i7f:�Iilflla�Y� <br /> HFA <br /> r <br /> >w <br />