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4C L <br />Geological Audit Services, Inc. <br />�. �.� En�ironmen�a/Professibna/s <br />1803 West March Lane, Suite A - Stockton, California - 95207 - (209) 956-0264 <br />Client / 1; -; rJ <br />®ject Name <br />t�oject Manager <br />Phone Number <br />Samplers: (Signature) <br />V'/'� n <br />CHAIN OF CUSTODY RECORD <br />Date 2-1k <br />' C .o Page % of / <br />Tests Required <br />Invoice: <br />/eoAudit <br />Client <br />A <br />Sample Type <br />� � w <br />No. �((/} / / <br />Sample <br />Number <br />Location <br />Description <br />Date <br />Time <br />Solid <br />of ;� ;� Notes <br />Conts. �' <br />Water I <br />Air <br />Comp. I G.,ab. <br />7,1. <br />3 <br />X <br />x <br />- <br />.r <br />t / L• <br />l� �1 .^ter Y • rJ:.v°"'f� .[! <br />� �`'� <br />K <br />.y <br />ved by: ( r 14T Date/Time <br />d by: ( rgna u <br />Received by: (Si ature)D te/Ti e <br />161,..quishe <br />hed ure) <br />Received by Mobile Laboratory for field analysis: (Signature) Date ime <br />quisheo by: (Signature) <br />Dispatched by: (Signature) <br />Date/Time <br />Received for Laboratory by: <br />Date,Time <br />Method of Shipman i1 <br />Laboratory Name <br />Special Instructions: <br />/ f <br />I hereby uthorize the performance of the above indicated work. <br />A <br />