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4C 7* <br /> CHAIN OF CUSTODY RECORD <br /> Geological Audit Services , Inc . Date�U 7ag� -� ofd_ <br /> �� Fr�Yironrr�e�ta Professiona/s <br /> �" 1803 West March Lane, Suite A- Stockton, California-95207-(209)956-0264 <br /> Client 60tj ��L.- �� Project Manager <br /> Tests Required <br /> 'rzoK Z Z5 `7 Phone Number <br /> Taw— <br /> Samplers: (Signature) �Invoice: <br /> t1 l <br /> Project Name VAI C-�!2"7 � [Z GeoAudit ❑ <br /> Cli <br /> Sample Location — Samp e pe r V\ / / <br /> Date Time Water Solid No. of / ; Notes <br /> Number Description <br /> CoAir Cants. <br /> mp. Grab. � <br /> r- <br /> G 1 Z oar E citt. - c 12.r Jr:6-Z) -- - ----- K 36527 <br /> 36528 <br /> s � � 5 GiauT-►i� ��� C� S� �-�,�S --- _- - -- i <br /> 3552 � <br /> 36530 <br /> Ii uish ignature) Receive Vsxnature) _ gate/Time <br /> elmquished by: (Si ature) Rece y: (Signature) , Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) //t/ i `-' Date/Time <br /> Dispatched by: (Signature) Date/Time + Received tar Laboratory by: Date/Time <br /> Method of Shipment: F, --- - - Laboratory Name <br /> Special Instructions: t hereby authorize the performance of the above indicated work. <br /> GM <br /> Ae <br /> r� if/f�G <br />