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I <br /> � .� Geological Audit Services , Inc . CHAIN OF CUSTODY RECORD <br /> Date 1 -17~gy_ Page —Lof l <br /> Envnnninenta Pro/e"1ona/s <br /> 11103 West March Lane Suite A Stockton Calliornia 95207 (2091 956 0264 <br /> I♦r <br /> r <br /> I <br /> Client I apit r♦4 I n r 4 0 h Project Manager Tests Required <br /> Fo� M4rT <br /> Phone Number <br /> (�-Oa) gT6-O.' 6y <br /> i <br /> Samplers (Signature) <br /> - , Invoice <br /> Pro Name , �c� ' � GeoAudd <br /> � Top Ft�1,qty 5'�a�l o e-t � � <br /> o-h� Client ❑ <br /> Sample Location Sample Type d- <br /> Number Description Date Time Water Air Solid N o�t Q v Notes <br /> comp Grab <br /> 17-117 1-17-ai; i3-�3 �C 3 X Xy501 7 <br /> nw-A/ , - ,7-qy 'X 950 <br /> M w"3C 1 ' 17-47 13 X <br /> 19501 <br /> I <br /> •inquit• • by (Signature) <br /> e DatelTlme <br /> �� I-%4 44� _ P 1+a g.t t of c l ud i <br /> hngwa '1;l by (Sign,at • � R ftwowd Ir-VVe (51gn tura) <br /> Date/Tim l� <br /> nquia gnature) RaZolved by Mobile Laboratory for field analysis natural Datattime <br /> D+epalched by tsignalurey Date/Time Received for Laboratory by Date/Time <br /> Method of Shipment Laboratory Name <br /> Pam - At3pee3at laaeruettona1-1 hereby authorize the performance of the above indicated work <br />