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CHAIN OF CUSTODY RECORD <br /> Geological Audit Services , Inc . 3~� �q5 Page ? <br /> E17VlronmenlalPrrrofesslonaDate <br /> /s of <br /> 1803 West March Lane Suite A Stockton Calrlornia 95207 (209)956 0264 <br /> � t <br /> Client M r 1 O W 4 T'a Project Manager <br /> Bob MqVIX Tests Required <br /> Phone Numb r <br /> (;LO 7)q 36-0-.6 <br /> Samplers (Signature) Invoice i <br /> Project Name M ar I ow t- Pro,f y, �j•5 `�c71�� ,r\� GeoAudit ® , <br /> Client p <br /> Ili Sample Location Sample Type a. <br /> Number Description Date Time WaterAlr Solid f <br /> Con S ,`4'r Notes <br /> Comp Grab - - — <br /> Ii <br /> fe 3 61q W-00 a ' <br /> rro Y� �►y' X X - __5Q732 <br /> vw-)/13' y 1 �: ty x t X 507.33 <br /> a <br /> vw-1 15'to <br /> 15: toX <br /> x I <br /> VW-1 _ <br /> w-1 417Op r w} <br /> 1 7l0 0 07-3-4 <br /> 50735 <br /> e inquis ea by ( ignature) ecei e yIS! <br /> gna <br /> xm', ti Datelrime <br /> Relinquished by {Signature) ti 3-7'q $; q v <br /> Aocetved by (Signalure} <br /> Datelrime <br /> Relinquished by (Signature) Received by Mobile Laboratory got field analysis (Signature) <br /> Date/time <br /> Dispatched by (Signature) Date/Time Received for Laboratory by <br /> Date/rime <br /> Method of Shipment <br /> L <br /> 1aboratory Name <br /> ,� <br /> Special instructions r ' t 6ampb4 <br /> VomIIrfryJ'kr ri.l�� I hereby authorize the performance or the above Indicated workI <br /> • l <br /> GOOC C fit' AIr'I'M(TIATj _ r _ _ <br /> Allurn <br /> HEM MTV- _ <br />