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CHAIN OF GUSTO ECORD <br /> Geological Audit Services , Inc . Date to ltskPage ---�— of <br /> Enw1ynmew-?1Profess1017, Cs <br /> 1803 West March Lane Suite A-Stockton, California 95207 (209)956 0264 <br /> moor <br /> r <br /> ClientProje` Manager _ ` Tests Required <br /> W <br /> Phone Number <br /> Samp! rs (Signature) ,�� ,�y / /Invoice <br /> /GeoAudit ❑ <br /> Project Name �.�� LAS + / Client ❑ <br /> Sample LocationSample Type �' �/ <br /> Date Time Water Solid No of / Notes <br /> Number Description Comp Grab Air Conts <br /> 3 X� <br /> e i{}quis y ( ignature) Receivedy (Signature) Date/Time <br /> Y� l=f�c. z w4-m�C��� st,,�•.t.<.� /,�����r 3 �t�'"t <br /> Relinquished by (Signature) Received by (Signature) DatetTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Dafe(Time R rved for Labo atony by Date/Time al <br /> �4t� CU t 110-2&-qb 1a3� <br /> Method of Shipment Laboratory Name <br /> Special instructions t hereby authorize the performance of the above indicated work <br />