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CHAIN OF CUSTODY RECORD <br /> -� Geological Audit Services , Inc . ��_�$ _� <br /> _ Enwinnmenta/P�nless�ona/s Date— y P age ot <br /> ... <br /> � 1803 Weal March Lane, Suite A Stockton California 95207 (209)956 0264 <br /> I <br /> Client fl tit' \4/ qJT Project Manager <br /> Bob Mar) Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> Project Name AV-00 M i N( MarT '� w°''`� d `Q GeoAudlt P <br /> Sample t.ocatlon Sample Type , <br /> titi 1 Client p <br /> Number Location <br /> Date Time Water Solid No of ;`'� �; Notes <br /> CompGrab Air Conts / <br /> dos- o I90-a <br /> e mgws e y rgnature ecerve y rgnature <br /> 7� Ilk 5TaviJgYd A,T'- DatelTime <br /> Relmgwshed by (Signature) Rec /I) <br /> ve by (Sr net o} /� gyri DatelTime <br /> �~ JJ <br /> Relinquished by (Signature) Roce ve y Mobile Le ratory for hold analysis (Signature) DatelTime <br /> Dispatched by (Signature) DatelTime Rocerved for Laboratory by DatelTime <br /> Method of Shipment Laboratory Name <br /> Special Instructions 1pho( <br /> s 1 hereby authorize t`he performance of thisabove indicated work <br /> Avt frvt, )l4v�' <br />