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-4C CHAIN OF CUSTODY RECORI <br /> Geological Audit Services , Inc . <br /> EnV%ronmen1a Professions/s Date 6-111. 91- Page �_ of-L_ <br /> v--- <br /> New <br /> 1809 West March Lane, Suite A- Stockton, California-95207-(209)956-0264 <br /> Z�tCS &A56 <br /> ClientC Project Manager <br /> 6GDe0u*5 /L�+�Z ('T 4� Tests Required <br /> Phone Number <br /> 2� <br /> Sample sI: (Signature) Invoice: <br /> Project Name ` <br /> GeoAudit,18 <br /> Client [ <br /> 1 Sample Location Sample Type <br /> No, of <br /> Number Description Date Time Water Solid / Notes <br /> Comp. Grab. Air Conts. <br /> Ski- 1 5ryI >'4-44 V-40 �( ( . <br /> (ILL..� � 4 •. t. `� <br /> SPi- Z � Tr. <br /> 5�3-Z Z tS ( rA_ y SPs-1 MP3-2 <br /> z zs k �, <br /> guts a y: rgnal r e er c y: r n ure ' ` �Atr�ni7L 171'7 <br /> - Date/Time <br /> in uished b yQ�� �,'/t> <br /> Q y: (Signature) Received by: (Signature) ll <br /> R A Dato(Time <br /> Relinquished by: (Signature) APO -3I�t� <br /> Received by Mobile Laboratory for field analysts: (Signature) <br /> 7--�M � Date/Time <br /> Dispatched by: (Signature) Date/Time Receivedy for Laboratory by: <br /> --T--Date/Time <br /> -- <br /> Method of Shipment: <br /> V0111" <br /> 01iLaboratory Name <br /> __ <br /> Special Instructions: <br /> 6-6oD G��rJ�ni r� APPROPPATF I hereby authorize the performance of the above Indicated work. <br /> iI M- SWE WENT <br /> /1/1.FT.I.II f1/1 <br /> 1 <br />