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- .�� Geological Audit Services, Inc. CHAIN OF CUSTODY RECORD <br /> Dale ol� <br /> .r <br /> Client <br /> PROJECT MANF"ER <br /> PROJECT NAME <br /> S.: : -„: <br /> SAMPLE LOCATION I DATE TIME t.:r-_R AIR SOLID No OF TESTS <br /> NUMBER DESCRIPTION f` CNTNRS REOUIREO t <br /> 3 <br /> ` <br /> 3, 7-61 Ii 3 25 x <br /> I <br /> 1 f <br /> I <br /> lael ma ed {5.9natur I Received by (Srgnatu+e) <br /> ' ,t � ! � Date/Time <br /> n <br /> Relmau-sned ay {Signature) Rece-veC Oy IS,(;nature) �A Ab� Date/Time <br /> RehnGui S')?C t3y (Sena Sure) Rece,ved OV Moque Lanora:o- IC' ' - c ai�a y5 5 <br /> Date/Time <br /> !Skgnalure) <br /> Drspaicned Dy(Signature) Date/Time Ptece-ec 'o, _ac�•a:ory Dy Dale}Ttme <br /> Method of Sh,pment. i hereby aulnor+ze the performance of the at)ove indicated work <br /> Special Instructions: <br /> en.,a^r .......� ......��a pPa iq�5 <br />