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CHAIN OF CUSTODY RECORD ' <br /> mgz � . Geological Audit Services , Inc . Date -32'"L- page —3 of-3_ <br /> +"`� En>'ironmen�a Profess,�ona�ls <br /> 11w1"-AV 1803 West March Lane, Suite A • Slocklon,California-95207 •(209)9560264 <br /> rtia-� sss a° <br /> project Manager Tests Required <br /> Client 5'T��K �o�z SPr ,r►co 51d ��Or� Ke-vivi M `KibbQ <br /> Phone Number <br /> t�-oy1q �'6' -0A6q <br /> Samplers: (Signature) - -� / Invoice: <br /> 1 24'Lv' Wt.c� ,VI �` ' `GeoAudit <br /> Project Name A Wi yq j Gq M O �t i yt ,,} Client <br /> Sample Location Sample Type No. of Notes <br /> Date Time Water Solid q . <br /> Number Description comp Grab. Air Conts. <br /> Sour easy 5)vc �p� t <br /> d1=- <br /> I <br /> C;43 I <br /> 34919 - -- <br /> 52 ^ 16r� bjj K I 1 I <br /> 5 2 34920 <br /> - �` 1, l,� FX c U vtt �IS� �o o� -- ` ; <br /> IV <br /> —H { NoY't4 1i El f f i� ! �.� 0 x 1 t 14921 <br /> - 45- 1 ti 1 ti <br /> eeh7ur , �t5 ' 34922 <br /> w-414 ' t <br /> 51 c�a <br /> Date/Time <br /> eH e : ( rgnature) -._ ec�e y:B.9-6 2 v <br /> WorMuished by: (Signature) Received by: (Signature) Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field annlysis (Signature) DatelTime <br /> Dispatched by: (Signa(ure) DatelTime Received for Laboratory by: Daleffime <br /> Method of Shipment: laboratory Name <br /> _ ) 4t.�r`t► ls�l��ii � � �-rxltiipbR 1 <br /> Special InstrucH "'' z-._-- I hereby authorize the performance of the above <br /> indicated work. <br /> od�0®C0NB9�41 _, ��I�I~'ROKIA1I= w:�, <br /> air <br />