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llllllllllllllll� Illlllll� I• I♦ tI♦ � �■ •� ifi � tl, fllll�_ _, r,r� s� <br /> CHAIN OF CUSTOM- ECORD <br /> Geological Audit Services , Inc . nate. -� p-1gn Of <br /> -- EnY�r�rmenla/Pmfessrivna,Cs -- <br /> -�— <br /> �� 1803 Went March Lane, Suite A-Stockton, California •95207-(209)958-026, <br /> s a 35' Y <br /> r <br /> Client Pro Pct fAanager <br /> LD M Tests Required <br /> 1(0 • LIVIr:5- Phone Number <br /> 9 <br /> L CAV ! Samplers: (Signature) j /� /. Invoice: <br /> Project Name <br /> .1�� �" , /� ' GeaAudit <br /> ' ,�0 Client ❑ <br /> / / / . <br /> Sample Location Sample Type Slid No. of -�� '�� <br /> l / <br /> Number Description Date Time Water o / + 34923 <br /> � <br /> p Comp. Grab. Atr COntS. <br /> MW-ln Z'Zsn 7 34924 <br /> f <br /> 34925 <br /> 1414' J-t6 7.I{Di'M �] ; 34926 <br /> - 34927 <br /> �1•ta a 31(orm 7 34928 <br /> "14-r 1-u q 3;119 9 <br /> -f <br /> 4'3d l 211 <br /> el" qu,s e b ( Ls nature) Roca d by: (S--fiature) rte•, 7Z 6`e} '�elf�e/T6me <br /> nq shed by: (Signature) Received by: (Signature) Da erTime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) i Dalerrime <br /> Dispatched by: (Signature) DatelTime Received for Laboratory by: DaterTime <br /> Method of Shipment: Laboratory Name <br /> Special Instructions: t;' � ,C{� �' L� I hereby authorize the perto,rmance of th above indicated work. <br /> I <br />