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CHAIN OF CUSTODY RECORD <br /> Geological Audit Services , Inc . Date % ' 23 ���� Page �- of <br /> Environmen/a/P�ofessibnaCs <br /> 1803 West March Lane, Suite A- Stockton, California-9520.7-t209) 356.0264 <br /> Client ' Project Manager I <br /> Tests Req=uired <br /> 5 0 1•f 5 <br /> P',a e ) \! <br /> Phone Number <br /> Samplers: (Signature) C11 <br /> \ ,`' �� Invoice: <br /> Project Name �' GeoAudlt �] <br /> -c��.�,(r(,�, L s`"1� h � �, Client :J <br /> Sample Location Sample Type ( �' ,y, 4- <br /> Number Description I Date Time ( Water Solid No. of ;��`%�, �f �, Notes <br /> i camp crib. Air Conts. <br /> T ` _ = iCIAi4 "/��/q3 `� ��' 1�3-("�tGDIJ/ <br /> � j <br /> LlCi <br /> i <br /> Relinquis4 a by: 1 ignature ec e i tur <br /> rX' Date/Time <br /> Relinquished by: (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 Received for Laboratory by: Oate/Time <br /> Method of Shipment: Laboratory Name <br /> Special Instructions: 1 <br /> 1 -I a /^� 1 hereby authorize the performance of the above indicated work. <br /> fa <br />