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r r�lrmoo= I 111110_ �! <br /> CHAIN OF CUSTODY RECORD '- <br /> =� <br /> Geological Audit Services , Inc. Date -i'�-�3 Page a of <br /> =V1 EnWM71n 7ta Phof&ssio & <br /> lsaar 1805 West March Lane. Suite A-Stockton. California-95207•(209)958.0264 <br /> r.+ <br /> Client Ll�� G�d Proje Manager <br /> > i L 64�6� Tests Required <br /> Phone Number / <br /> Sam 1ers: (Signature) / /' / / Invoice: <br /> Project Name n 1 GeolAudit f <br /> r�� � ��TS 7fz/// // ClientSample LocationSample Type Date Time Water Solid No. of Notes <br /> Number Description Air Conts. <br /> Camp. Grab. <br /> 6 -4 t�.5,0 t I <br /> ev V--so 2" 10 X t <br /> Relinquished y: <br /> / (Signature) ece ve y (Signature <br /> Date/Time <br /> c r $-19 Cr t11 e;l <br /> Relinquished by: (Signature) Received by: (Signature) DatelTime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis. (Signature) DatefTime <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: DatelTime <br /> Method of Shipment: Laboratory Name <br /> Special Instructions: I hereby authorize the performance of the above indicated work. <br />