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(� IIIIttw tttttift� <br /> CHAIN OF CUSTOD ECORD <br /> it,z Geological Audit Services , Inc. Date 5' 17 �2 Page Of <br /> KvE7Y11 rrmenl Pro/essbna(s <br /> ►� 1803 West March Lane Suofe A Stockton California 95207 (209)956 0264 <br /> Project Manager <br /> Client G G bt u _ Bc,", 14a"7 Tests Required <br /> Phone Numbe <br /> { 1 o c K I o A C /3 1-7 5 Samplers (Signature) / Invoice <br /> Project Name TJ ��� i � �� � �s GeoAudlt ❑ <br /> r—Me(t <br /> Sample <br /> Sample Location Sam P Type No of � <br /> Number Description Date Time Water reb Air <br /> Lo <br /> S � Notes <br /> Comp <br /> 4 P-1 Jj M ti-? I 30 <br /> e onquos a y 4 ognature) Received by (Signature) Date/Time <br /> A �i�.u7 ,(,- 511aAvJ T it T 3/�r/v3 - ! 7-00 <br /> Relinquished by (Signature) Received by (Signature) Date/Tome <br /> Relm a ure) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) v$d [or La bo y D (Tome <br /> Method of Shipment Lsb Mame <br /> Special Instructions I hereby authorize the performance of the above indicated work ` <br /> I <br /> PL )�� <br />