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CHAIN OF CUSTODY RECORD - <br /> _�_ Geological Audit Services , Inc. Date roLg3 Page of <br /> =�� Enf✓irnnmenta Prnfess�lvnae*s � <br /> �-� 1803 West March Lane, Suite A-Stockton, California-95207-(209)956-0264 <br /> I• <br /> Project Manager <br /> Client }�q�y,jS� T 50 5 F6 Maell Tests Required <br /> Phone Numb r <br /> Samplers: (Signature) �� ''b Invoice: <br /> a y <br /> eoAudit C& <br /> Project Na <br /> meq✓ l 5 So 9 - 1n/ i 5 0 h Lv a /GClient <br /> Sample Type <br /> Sample Location Solid No. of Notes <br /> Comp. Grab. <br /> Number Description Date Time Water 5t <br /> p Ar Con s. '` G) <br /> Tq Y 15 Io-�-q7,- I use D-I. wd7-pi, <br /> dor WET m- lc(15 <br /> Relinquished y: ignature ecerve y: ,gnature Date/T' <br /> Y'at1 ���� 1 d-Q•Q)!11: 7 <br /> Relinquished by: (Signature) Received by: (Signature) Oatelrime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time eceived for Laboratory by: Da e/Time <br /> Method of Shipment: Laboratory Name <br /> WF- 5 )- <br /> Special Instructions: I hereby authorize the performance of the above indicated work. <br />