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r rr Ml M M M M IM r <br /> CHAIN OF CUSTOD ECORD <br /> (geological Audit Services , Inc. Date °�!i�i Page _ i of 1 <br /> T=V j:'nt/irmmant Professbna,& <br /> lNaaw 1803 West March Lane, Suite A• Stockton, California• 95207•(209)956-0264 <br /> r <br /> Client Project Manager <br /> Tests Required <br /> "1 <br /> Phone Number <br /> ,v <br /> Samplers: (Signature) Invoice: <br /> Project Name 1' y 1 .s ,` `�- '• ��, f, GeoAudit <br /> :/ Client ❑ <br /> Sample Type <br /> Sample Location Date Time Water Solid No. of <br /> Number Description Air ,� Notes <br /> Q Comp_ Grab. <br /> CG i <br /> X <br /> ,F6 '"b C' <br /> i dry_ 50 �`It3l <br /> -7 <br /> 6-D i t n <br /> r x/93 13� 'i L) <br /> Relinquished y: ( gnature ecerve y: (Signature) DatefTime <br /> f �ti i ����q�� Tyr- '41Y1g717--g- <br /> Relinquished by: (Signature) Received by: (Signature) Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for held analysis: (Signature) DatefTime'� <br /> Dispatched by: (Signature) _ �D Received fo ab story <br /> DatefTime <br /> Method of Shipment: A Jy W.E-S.T. Laborra�tor Name <br /> �� <br /> Special Instructions: date I hereby authorize the performance of the above indicated work. <br />