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�Ic � <br /> CHAIN OF CUSTODY RECORD <br /> _� �-- <br /> Geological Audit Services , Inc . Date x423 '2 Page <br /> E17 V1, Pip/BSS/01731S <br /> =V <br /> 14 <br /> 1803 West March Lane Surto A Stockton California 95207 (209) 956 0264 <br /> 96 D �000�S� <br /> Project Manager <br /> Client Lk a r IV 5 5 !4p b►ct 1� Tests Required <br /> Phone Number <br /> (209) R 5 4 <br /> Samplers (Signature) � / Invoice <br /> Project Name G q(-v��I5 4ul U �A Pc(I y' � 1 14 Lc �ILG , , GeoAudlt <br /> \� Client ❑ <br /> Sample Location __ Sample Type-l_—_ _ No of <br /> Number Descnptlon Date Time --W,itr r Air <br /> Solid Coats �i`��i ' Notes <br /> Collip C[Tit) <br /> a inqus a y "gnature uLury 1n)Aura DeielTrma <br /> 1�3t/�hq�< �`w���"1 — -- �= - _ -- fllapV.U, f cluLIk Gtr/Q(r 9 -16 4N/110O <br /> Rehnqurs (Srgnehr Il+ — b Srgnuturu) i Date/ rme <br /> /.��-�_� _ <br /> Re u by Signature) llocarvud by Mobrla Latrornlory for hal+1 .)nalys+s (3�r rlurc) ate/Trme <br /> Dispatched by (Signature) hura ory by Oale/Truro <br /> Method of Shipment Laboralory Name <br /> P'?V1 - A <br /> Special Instructions I hereby authofrzo the performance of the above indicated work <br />