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t� titiiiiiitif tti�� t� � � � ti fit! t�� tttw■w �� t■tw� t�wt1� t11�1! i� t�A1 +�� <br /> CHAIN OF CUSTOqWECORD <br /> Geological Audit Services , nc . Datei`a-2,`i-Y3 Page _J_ of <br /> — -�V= En�ironmenta Professionals <br /> 1603 West March Lane Suite A Stockton, California 95207 (209)956 0264 <br /> Project Manager Tests Required <br /> Client <br /> AVT \A1 Y C117 _ if i c C�.�V v e <br /> Phone Number <br /> Samplers (Signature) 7 /Invoice <br /> /GeoAudlt ❑ <br /> Project Name AYcd M?',il MaV] / � Client ❑ <br /> K, bberi <br /> j„� <br /> Sample Location Solid No of Notes <br /> Date Time Sample Type Water b <br /> Number Description Comp Grab Air Conts � �b/ <br /> 3 (OMP00. Pro M.1 c+�"�9.9� !t; 110 i NdllI!01fgI Solgy)4 <br /> for Tc57 ovcbv�s <br /> 16 -Y3 <br /> i <br /> e inquis a by (Signature) Receivedy ignature DatelT me <br /> y +l�ra <br /> p <br /> Relinquishedbyi(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 ReCeIVr Laboratory b ate[Time <br /> [k I L <br /> Method of Shipment L or tory Name <br /> Special Instructions I he eby authorize the performance of the above indicated work <br />