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CHAIN OF CUSTODY RECORD <br /> Geological Audit Services ' Inc . Date 12-6 -1 Y Page 2, o# Z <br /> G7 5nV1MnMe17t7Pro16SS10na/s <br /> Now�— 1803 West March Lane Suite A Stockton California 95207 (209)956 0264 <br /> Client �e fD�to Project Manager Tests Required <br /> FAQ <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> Project Name 67-moi" ue bas Z /�G� �q GeoAudrt �J <br /> A <br /> Client ❑ <br /> Sample Location Sample Type <br /> Number Date Time Water Solid No of V� <br /> Description Air Conts Notes <br /> Comp Grab <br /> b - ID Irl k Y 1i'01 X <br /> IJ <br /> - � � LJ <br /> x <br /> LLL <br /> el is ignature a rveii <br /> 'a�� � r� T— p e(Tima <br /> �� , <br /> Re qu (Sig e) cel / <br /> al /Time <br /> y tui Received by Mobile Laboratory for held analysis (Signature) <br /> ate ime <br /> Dispatched b (Si naturg� Date/Time Received for L b ra ry by r <br /> �.�9�_ Date/Time <br /> Method of Shipment Laboratory Name _ <br /> Special Instructions <br /> I hereby authorize a performance of the above Indicated work <br /> MIA l♦ l♦ � <br />