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CHAIN OF CUSTODY RECflPu - <br /> _= Geological Audit Services , Inc. aaa <br /> t,� pge of <br /> 11rFaY f803 West March lane, Suite A•SI"Wart, California-95207-(209t 958-0264 <br /> L <br /> Client �' _ / Project Manager Tests Required <br /> Phone Nurrber <br /> Sam Fars: ISignaturr l ,i ..' ` / 1 Invoice:: <br /> Project Name ` ; , .'GeoAudit.M, <br /> Client <br /> Sarnp e Type f `�, <br /> Sample location solid t No. of -' Notes <br /> Number Description Date Time Water <br /> p Air Conts. - <br /> -i Comp. Grab. <br /> ZO —, <br /> _ 35220 <br /> ,Y <br /> ii <br /> 77 <br /> r� <br /> pl�mmv <br /> llm <br /> �` IIC14i! , nldf <br /> F' <br /> L qussA y: { ignet a eos ay: Fgn re ��',�� UatelTime <br /> L tehnquished by: (Signature) Received by: {Signature} <br /> OatelTirne <br /> tetinquished by- { ignmure} Received by Mobile Laboratory for 60d aneiyais (Sigealure} DatelTima <br /> I� <br /> iispalched by, (Signature) oaterTime Received br La'toratory by. anterrime <br /> _J7 <br /> T; lethod of Shipment: Laboratory Name <br /> _-A <br /> II gecial instructions: I hateby sulhotize the performance of the above indicated work. <br /> 7 <br /> 3 <br />