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CHAIN OF CUSTODY RECORD <br /> =--�= Geological Audit Services , Inca ,o_ {�_yf� I <br /> En�irnninen/a/Pin/essiona/s Date Page of <br /> ;9=7 <br /> NNW <br /> v--- <br /> 1e09 Weal March lens.Sults A•Stockton, California•95207•(209)956•0264 <br /> 3161 ' <br /> TientProject Manager j <br /> A If y<d Cq I d r0 60 <br /> b MQ k_ ' Tests Required <br /> Phone Number <br /> ()-0q) '166-0,X61 <br /> Samplers: (Signature) Invoice: <br /> roject Name ( a d y.OW 5 M 4 r K e T ` th`X"4u �� GeoAudit <br /> Client p <br /> S_. pie Location Sample Type , <br /> Date Time Water Solid No. of q�, �� Notes <br /> Number Description corm, crnb. Air Conts. <br /> -730 <br /> jwt - 1D 9: t0 X I X = - 41731 ' <br /> : <br /> M ;'- 10 1 :30 X 1 X ; 41733 s i <br /> MW3 y I3:140 X I �( 41734 <br /> _ <br /> t4W3 )a i3,y 5- X - 41735 <br /> I <br /> i <br /> mel, • y: igpture c vo i nature Dats/Time j <br /> 7'tt,cl4r," 5)(144,J t-A.T. <br /> r qufs (Siq lure) {e-IQ�q/15'�y <br /> i <br /> Received by: (SignaTi <br /> DatelTime <br /> Relinquished y: (Signature) Rocoivod by Mobile Laboratory for field analysis:(Signature) Date me <br /> . t <br /> Dispatched by: (Signature) Dato/Time Received for Laboralory by: Date/Time � <br /> 1 <br /> Method of Shipment: Laboratory Name <br /> To <br /> Special Instructions: t; 17 , T 1 hereby authorize the perlormance of the above indicated work. <br /> RIM <br /> 0000 06140 tR1 �__ _ 94,4G ' <br /> �RUPF Iti E i <br />