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- --- <br /> __ CHAIN OF CUSTOD ECORD <br /> Geological Audit -Se-rvices , Inc . pie I ZPage of <br /> _ __ ==� EnYironmenta/Professbna,Gs <br /> Ua��� ---= <br /> 7803 West March Lane Suite A Stockton California 95207 (209)956-026 <br /> Probean <br /> Ma er <br /> C - - rg Tests Required <br /> Phone Number <br /> _ Samplers (Signature) Invoice <br /> GeoAudd ❑ <br /> Project Name r� u - <br /> -C t { r�(,c.e_. Lr�. ��G.�s,��t.� ► Client ❑ <br /> = Sample Location - - Sample Type Solid No of � Notes <br /> Date Time Water <br /> - - Number - Description =_ _ Air Conts _ <br /> Comp Grab <br /> }! '3u - rr 3o <br /> e tquis a (Signature) — Received by (Signature) t]ate/Trme <br /> Relinquished by (Srgnature) - ature) Sr`""-"-� ` Daterrlme <br /> Relinquished by_(Signature) _ Re e a Lacsld <br /> if natys s (Signature) DatelTime <br /> Dispatched by (Signature) - ahrrTlmd, Received for Laboratory by Date/Trme <br /> _= Method of Shipment — — — - Laboratory Name <br /> _ Special Instructions -- — - _ I hereby authorize the performance of the above indicated worts <br />