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I <br /> i <br /> Geological Aud <br /> it Services, Inc. `+ <br /> CH IN of CUSTODY . :oRD <br /> /� -Da le <br /> Page�of� <br /> client — L CItJ - J4,� PROJECT MANAGER <br /> PHON=_NUMBER L <br /> PiiOJECT NAME � f <br /> SAMPLER :(S..�''ature) <br /> SAMPLELOCATION DATE SAMPLE TYPE <br /> NUMBER LOCATION <br /> TIME WATER AIR SOLID NO.OF <br /> COW. Crab. CNTNRS TESTS <br /> REOUIRED <br /> 10 <br /> i <br /> µ <br /> .,I <br /> Relinquish¢ b X K <br /> Y�iS' nplure! . <br /> i� Received by:(Signature) — <br /> Ii 4.�et---'-J DatalTime <br /> Relinquished by:(Signature) <br /> Received by:(Signature) <br /> — <br /> DaterTime � <br /> Relinquished by:(Signature) IS <br /> Received by Mobile Laboratory for held analysis: <br /> (Signature) DaferTlme�� <br /> Dispalched by:(Signature) <br /> Oate/Time ecenw:d for Laboratory by; <br /> L �' J DateiTime <br /> Method of 5hipmnt• ` L <br /> I hereby authorize the peri rrmance of the above indicated work. <br /> Special Instructions-. <br /> i <br /> SOURCE.,Adapted from U.S.EPA,1985 <br /> -5 <br /> -72-3 <br /> I <br /> i <br />