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Ll <br /> — _ _ CHAIN OF CUSTOD ECORD <br /> =� Geolo Kcal Audit Services Inc. �� , -g3 t <br /> = T=w Emer�t Prt�feSsilanafs <br /> Date ""4 Page <br /> ssaAW 1003 West March Lane Suits A Stockton California 95207 {209)956-0264 <br /> low i <br /> Client A r r f aI"t .0roject Manager Tests Required <br /> Vic Cliervem <br /> Phone Number <br /> Samplers (Signature) ��'� //Invoice <br /> Project Name A P c r) M i h l it"�ar r i �s� / / ent <br /> Sample <br /> p Sample Type No of � <br /> Number ple Location Date Time aver Solid Q�Q� / �� Notes <br /> Comp Grab Air Com <br /> - q3 6^9'g3 11: ;L5- X <br /> Relinquished y oanaturs e v y i ature S7andar� Datelrime <br /> Relinquished by (Signature) Received by (Signature) DatelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory fdr field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Received for Laboratory by Date/Time <br /> Method of Shipment Laboratory Name <br /> At ph <br /> Special Instructions f hereby authorize the performance of the above indicated work <br />