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IV � <br /> CHAIN OF CUSTODY RECORD <br /> Geological Audit Services , Inc . Date I -z7-�'�� Pa i <br /> Enwrnnmenta Profession/s 9 of- I— <br /> low <br /> 1803 West March Lane Suite A Stockton California 95207 (209)956 0264 F <br /> ti <br /> r <br /> Client tlCty,��,, �ir� fir-'-�3S Project Manager <br /> vob h(d y`�, Tests Required <br /> Phone Number <br /> (.r�o CO FC-016�J <br /> Samplers (Signature) Invoice <br /> Project Name Mr la w e } <br /> GeoAudlt Vo <br /> h <br /> Client p <br /> Sample Location Sample Type ` <br /> Number Description Date Time -Water Air Solid Contsf � toy Notes t <br /> Camp Grab <br /> w-q�l - 17 <br /> M gyp <br /> Relinquished y rgnature ace y5�,, <br /> lute <br /> CI�4l'(�fd�C �. tefrlme <br /> flair (Signa Receive rej <br /> ��' t 3jrlly <br /> Re rnqurshed by (Signature) <br /> Receive abor ory for held analysis (Signature) Datemme <br /> Dispatched by (Signature) DaIme Received tot Laboratory by <br /> DatslTims <br /> Method of Shipment Labor r N e <br /> Special Instructions <br /> I hereby a oriz the pe rmanc a bov Indicated work <br />