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CHAIN OF CUSTODY RECORi <br /> Geological Audit Services , Inc . 32 s - z - 4 <br /> �`+ EnvironInentaIProfessionais 7 Date '� 1 Page I of <br /> _ 1803 West March Lane, Suite A- Stockton, California-95207 -(209)956-0264 <br /> r <br /> Client G; o f 5 70 CA 7 0 0 Project Manager <br /> 14 e v"n N Tests Required <br /> Phone Number <br /> �9-o9 ) g5S-- 0Z�� <br /> �L <br /> Samplers: (Signature) invoice: <br /> Project Name M u c'1,04 5�Y v; c P C yx4. GeoAudit <br /> �r <br /> a� Clipnt <br /> Sample Location Sample Type ah <br /> Number Description Date Time _Water Solid No, of , <br /> Air Conti. Notes <br /> Ccinip. Glab. / <br /> B 1 2 D Porr�9*� r 103,+ <br /> 6 10 <br /> l elfin. qusshed by: <br /> �(_Si6gnat�u/re/ fieceived b ignature) r �y! ,n �- <br /> elfin uish byT, �iYif9'L �`/ � �77UNc(q" alelTime <br /> f r <br /> Relinquished by: (Signature) Received by: (Signature) jt�t5� i h C 1 U 4a Q � <br /> Dale(Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: {Signature) <br /> DatelTima <br /> Dispatched by: (Signature) <br /> Date/Time Received for Laboratory by: <br /> Deta(Tim• <br /> Method of Shipment: <br /> Laboratory Name <br /> 5 <br /> Special Instructions: <br /> I hereby authorize the performance of the above indicated work <br />