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M A M M s M M M w M M M M ! M M <br /> O CHAIN OF CUSTO RECORD <br /> __ ---- <br /> Date-10- '7__ Geological Audit Services , Inc . ` �' <br /> �"� EnYironmenta/Professiona/s ``��' Page —L oC <br /> low 1003 West March Lane,Suite A-Stockton,California-95207-{209}956-0264 <br /> Client i1u 11 DIn , 5u 1 Va '� ��w`�aV1 Project Manager <br /> vol Tests Regtrired <br /> Phone Num r <br /> (-6q) q 4 Dib+- ` <br /> Samplers: (Signature) /invoice: <br /> Project Name r �- i 5 7kytf-wl')`I�.� , rti, ��� GeoAudit <br /> h Client <br /> Sample Location Sample Type o- <br /> Date Time No. of Notes <br /> Number Description _ Water Air Solid Cants. Q� / <br /> comp. Grab, <br /> MW M )Q -7-qW <br /> Mw - l0 7-q+- 13-o 2 <br /> Mw -S'/10 - 7--q� <br /> KW -6(Ib 7_g� <br /> Mw -7/07-q q X 3 q <br /> Relinquished y: jgnatureIteceii e• y: e c}���dl r•�� y, Dale/Tkme <br /> 15 <br /> R <br /> e ( igna r >r Re s=ired Sipaatu e) -i/Dpal�erime <br /> by: snature} o <br /> god <br /> Rec iv a Laborator for field analysis:(Signature) Date/time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: t)ate/Time <br /> 7 <br /> Method of Shipment: Laboratory Name <br /> Special Instructions: 0 <br /> I hereby authorize the performance of the above Indicated work. <br /> i . <br />