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�r>, titfAiii� tf■i � � r� � fi i i i i i i <br /> CHAIN OF CUST iRECORD' <br /> Geological Audit Services Inc. -� � <br /> _ =�� Ermronmenta Professiona/s 9 �� � S Date 2�2� Page t of <br /> ter 1803 West March Lane, Suite A-Stockton, California-9207 (209)956 0264 <br /> ow <br /> r <br /> Client Gna K(�e SAGO b ru k Project Manager <br /> &" MCW6 —�1Ve✓{n Tests Required <br /> -70(o P. 16t �J"ao SWPe,-�- Phone Number <br /> 2�) q36-0).,(0q <br /> Samplers (Signature) ti /Invoice <br /> Project NameLQ,-Ls' <br /> l ✓J � 'b� � //eoAudit 64 <br /> LQ, S �1.t`[b [c2 p q 1►- .11llth -i, C �/ // Client ❑ <br /> Sample Location Sample Type <br /> Date Time Water Solid No of �,i ' Notes <br /> Number DescriptionAir Cants <br /> Comp Grab <br /> 903-ta0 q1 rt <br /> Y- `F <br /> e rnquis ed by (signature) eceiv igrtature _ DatelTrma <br /> /fir / /yIq ^,P 1 S Noflly�n�+� <br /> Relinquished by (Signature) Received by ( i Lure) `+ DatelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Dale[Time <br /> Dispatched by (Signature) DatelTime Received for Laboratory by <br /> Date/Time <br /> Method of Shipment � a Laboratory Name <br /> Special Instructions I hereby authorize the performance of the above indicated work <br />