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�4C CHAIN OF CUSTODY RECORD <br /> Geological Audit Services , Inc . Date 10 - 022 Page --L— of� <br /> ���� EnYironmenta Professionals <br /> 1803 West March Lane, Suite A- Stockton, California-95207-{209)956-0264 <br /> Client <br /> _ Project Manager Tests Required <br /> �4 K�1 a'f S�f3ck�t5 Jo U vtr Bob Mar�� <br /> P0- Phone Number <br /> (,"I ) a 56-02,6 -) <br /> Samplers:(Signature) <br /> Invoice: a <br /> h <br /> Project Name Wo 5�-e V I- L ' - XXI( �.a v� C <br /> �.� Ge Client ❑ <br /> Client � <br /> Sample Location Sample Type No. of / <br /> Number Description Date Time Water Air Solid Conts. � Notes <br /> Comp. Grab. <br /> Mw�1 �1D~ 8�f� 10 -$-q3 X x 7� <br /> Mwl-q /10-1 3 X <br /> Mw -,5/10-6-,?3 �1 x <br /> -Relinquish <br /> ad by: cgnat re receive y: JSignatureT Datefrime <br /> Relinquished b (Signature) Received by: (Signature) rRSu <br /> Y� ( 9 ���Q7� ��� S Date rime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) Date/-Time <br /> Dispatched by: (Signature) Date/Time R ceived for Laboratory Date/Time <br /> 1 r <br /> Method of Shipment: Cabo lialory me <br /> Special Instructions: 1 hereby authorize the performance of the above indicated work. <br /> r rr � ■■r I. �r r r r � r r r <br /> _ r rr r� r■� � rr <br />