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4 <br /> CHAIN OF CUSTO&ECORD <br /> Geological Audit Services , Inc . �s � �a��' Page Z- <br /> EnYifonmen4? Professionals <br /> Dateof <br /> faasW 1803 West March Lane Suite A-Stockton, California 95207 (209)956 0264 <br /> Pro ect Mana er Ff <br /> Client �� L� yp� � Tests Required <br /> CPhone Number <br /> SSG <br /> 14fM c q l�7.45 zvci 41,56-0 ZG <br /> S <br /> l <br /> Sam ers (Signature) Invoice r <br /> p E � � SI <br /> Project Name M j d C ff 1 Ani WQ/,c� `rte / GeoAudit LJ <br /> V Client <br /> i <br /> Sample Type <br /> Sample Location No of <br /> Number Description Date Time Water Air Solid Cants / Notes <br /> Comp Grab � <br /> V I I <br /> 153 <br /> Al I L I <br /> I <br /> I <br /> i <br /> �J <br /> € <br /> I <br /> >I <br /> e iniZ ignature Receivedy ignalure ,r,y� Date/Time <br /> ( v <br /> Relinquished by (Signature Received by (Signature) /_�[� � !Z�✓�- Date[Time I <br /> I <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Ttme r <br /> I <br /> Dispatched by (Signature) Datefrime Re c ry d fo Labor ry by Dale/Time i <br /> ii <br /> e' I <br /> Method of Shipment Laboratory Nam. e <br /> Special Instructions I hereb authors the performance of the above indicated work <br /> ,I <br /> ,I <br />