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CHAIN OF CUSTODY RECORD <br /> Geological Audit Services , Inc . Date �'r5 -� Page of I <br /> - - — EnYiron�enta/Professiona/s <br /> 1803 West March Lane, Suite A-Stockton, California-95207-(209)956-0264 <br /> Client F r(in K l Project Manager <br /> 1 Co 13o� Nctt^ Tests Required <br /> Phone Number <br /> (7,oq ) q9-6- 0),6"1 <br /> Samplers: (Signature} ��� Invoice: <br /> GeoAudit 4 <br /> Project Name F0 u r C o r o e N i R p s tct a raml' <br /> 0h .v Client ❑ <br /> Sample Location Sample Type No. of '� a/ / /�� <br /> Date Time Solid •� '�� 1 Notes <br /> Water <br /> Number Description Comp. Grab. Air Conts. �/ % �/ // /� # 0 U 9/ <br /> f3 I - 3a 10'0�� I %� 002loc- <br /> 13i - g5 to, 5 .XO3I� <br /> c — <br /> Y I X 00362 (a <br /> Relin ed�(Signature) eceived y: (Signal <br /> P�'� -Q� 57a LLQ V'Cl T-���.. Date/Time <br /> Relinquished by: (Signature) Received by: (Signature) Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Date/Time <br /> Method of Shipment: Laboratory Name <br /> Pao - Ar , <br /> Special Instructions: I hereby authorize-the performance of the above indicated work. <br />