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CHAIN OF CUSTODY RECORD <br /> Geological Audit Services , Inc . Date ���"9 Page L of Z <br /> Ena'ironinenta Professi0n.?1S <br /> 1803 West March Lane, Suite A-Stockton,California-95207-(209)956-0264 <br /> ENV114 n <br /> �',7>5 �D S <br /> Client A �, Project Manager <br /> �T- Tests Required <br /> Phone Number <br /> ZvQ qs-�-vLfo <br /> Samplers: (Signature) Invoice: <br /> Project Name <br /> 11 h GeoAudit tn- <br /> C& -b?-O"`s �`7� <br /> ���. ���� -�-/`Z� U� Client ❑ <br /> Sample Location <br /> Sample Type <br /> Number Description Date Time Water Solid No. of `� Notes <br /> p Comp. Grab. Air Conts. �/ <br /> Go11�5r7L <br /> 5 V4 <br /> i uis 'd by: (Signature) cery y: ( i n lure Date/Time <br /> 0 <br /> linquished by: (Signature) Re e' ed by: (Signature) DatelTime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) ✓✓✓ Dale rime <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Date/Time <br /> Method of Shipment: t�t ^�� -tl Laboratory Name <br /> " oo <br /> Special Instructions: =' i _ '� �Tt _ I hereby authorize the performance of the above indicated work. <br /> } 57�'tC Afs�fhTCam 'G <br />