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CHAIN OF CUSTOD ECORD <br /> Tom ;„ Geological Audit Services , Inc. <br /> Date 3—M- 93Page ofZ <br /> _ =�� Ent�iro�menla Protessnvna,Fs <br /> 1803 West March Lane Suits A Stockton California 95207 (209)956 0264 <br /> Client J�R Gork2J-,i Z� X65_ L Prod er Tests Required <br /> Phone Number i <br /> 1?5-6-dw 4-1 <br /> 5-5/6 3 07ZICA dN 64 Samplers (Signature) Invoice <br /> r <br /> dd <br /> Project Name /fw-cw 51h1L? JT I �4 Nt/'v y/_ � o /, GeaCl ent C]� <br /> Sample Location Date Time Sample Type Solid No of <br /> Number Description Water Air Conts Notes <br /> Comp Grab <br /> 3-to�g <br /> 40 3-Io¢3 �� I <br /> e rrtguis e y :1gnai ra Receivedy (Signature) <br /> Date/�tme <br /> tt sr�,vaprl� 3,�r�a3 <br /> 17 c� <br /> Relinquished by (Signature) -� Received by (Signature) Datefrime <br /> Relinquished b nature <br /> g y (Sr9 ) Received by Mobile Laboratory for field analysis (Signature) Dateftime <br /> Dispatch - Date/Time Re ed for Leborator <br /> DatelTime <br /> Method of Shipment / Laboratory Name <br /> Special Instructions r ; I hereby authorize the performance of the above indicated work <br />