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lam' <br /> CHAIN OF CUSTOD CORD-. ' , <br /> Geolo ical Audit Services , Inc . Date - Page <br /> of � <br /> - _ <br /> UAW <br /> .� Ent�ironmerita Professrona,(s <br /> � <br /> �AW 1803 West March Lane, Suite A-Stockton. California-95207-(209)956-0264 <br /> NNW <br /> Client �} Proje Manager I <br /> Tests Required <br /> Phone Number <br /> Samplers: (Signature) ;/ j' / Invoice: <br /> Project Name GeoAudit-k <br /> f <br /> — Client ❑ <br /> Sample Type <br /> Sample Location o. o7/1/ / <br /> / ~ ' <br /> tion Date Time —Water Solid NNotes <br /> Number Descrip comp. Grab. Air Ct7ntS. / <br /> Fw z', 35 <br /> R'wt 35 <br /> fc(x) 1+0 <br /> Relinquished y: egnature Received y: atur Data/Time <br /> Jam, -, -93 ZI6: ) F- <br /> Relinquished by; (Signature) Received by: (Signature) Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: <br /> Date(Time <br /> Method of Shipment: Laboratory Name <br /> Special Instructions: I hereby authorize the performance of the above indicated work. <br /> I <br />