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,..�� �� ....■ �wra w� www i <br /> - �� CHAIN of CUSTOD ECORD <br /> Geological Audit Services , Inc. Date rb`' 'a� Page t of <br /> En <br /> - =� �,ronmenta Professiona,Cs <br /> mow �1803 West March Lane, Suite A-Stockton California-95207 209)956-0264 <br /> a— <br /> Client Project Manager <br /> h V' OW gob marl ` Tests Required <br /> Phone Number <br /> �-oq Q56 - 0�� <br /> Samplers (Signature) ,/Invoice <br /> Project Name tae 10 rP�o �N�?off � �� tikt� � / J, �GeoAudit <br /> � Client E]❑ <br /> SampleLocation Sample Type a\ ��/ /� <br /> Water Solid No of a Notes <br /> Number Description Timeption Per 1ab•f 5 Comp Grab Air Conts <br /> g�-1646 —/3 —/ <br /> Relinquished y (Signature) ign tura f ` l_ r Date/Trme <br /> � L 5fa�dQa J r0-"� �r6 0� <br /> Relinquished by (Signature) wed b (Signature) d <br /> Y ( 9 ) � � r L/ Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatefTlme <br /> Dispatched by (Signature) Date/Time Received for Laboratory by Date/Time <br /> Method of Shipment Laboratory Name <br /> -IP40 l <br /> Special Instructions I hereby authorize the performance of the above indicated work <br />