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�4r ttt� t� <br /> CHAIN OF CUSTODY R CORD <br /> Geological Audit Services Inc . . o - ►�� <br /> =r-s� Page <br /> Dateof�— <br /> �_� En��ronmenta Profess�sona�s <br /> 14 1111� <br /> _ 1803 West March Lane Suite A-Stockton, California-95207 (209)956-0264 <br /> Client Project Manager Tests Required <br /> L- Phone Number <br /> U L0— 95 +VLi <br /> Samplers (Signature) Invoice <br /> •�I y �� GeoAudtt 2� <br /> Project Name Lpw1f6 el Al,fr f'"'v'►y" l Client ❑ <br /> i <br /> Sample Type <br /> Sample Location Date Time Water Solid No of � / Notes <br /> Number Description comp Grab At r Cants <br /> M w" - 30 � Vn V-yc-w Sr` 10-1x--`13 d <br /> Yew q — 3 Jt 35' ' I0 «1� �( ! <br /> "4— "10 rr 40 IOr1z�r3 I; <br /> e tnq s e ignature Receivedy �:Signature Date/Time <br /> i2 <br /> Rahw <br /> gsh by (Signature) Received b Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analy$is (Signature) Date/Time <br /> fGSS <br /> Dispatched by (Signature) aterrime Received for Laboratory by Date/Time a <br /> Method of Shipment Laboratory Name l; <br /> Special Instructions I hereby author)3e the performance of the above indicated work !' <br /> _ � A I <br />