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IC)/10) �� CHAIN OF CUSTODY RECORD <br /> Geological Audit Services , Inc . Date - -g3 Page _of <br /> _ =^� EnYiro�menta Profess,{ana,(s �4 <br /> Now" <br /> m03 West March Lane, Suite A Stockton, California 95207-(209)956.0264 Ueml- �r�C . <br /> Client �,-��� M�-�� Project Manager Tests Required <br /> Phone Number <br /> 26� 9L5-& -G zG� <br /> Samplers (Signature) Invoice <br /> 1 A4'P—�.E1(�L, QD�Z-t2'�[ �s ' c i�r+1 1 GeoAudst,EJ <br /> Pro ect Name M <br /> � Client ❑ <br /> Sample Type <br /> Sample Location Date Time Water Solid No of U / Notes <br /> Number Description Air Conts <br /> Comp Grab <br /> Mu13 <br /> Y.3 - <br /> M� DS I UAB 4 -36 �d' 1- 17 /.1 -3 <br /> Relinquished y (Signature) cery y na a <br /> I TA <br /> Relinquished by (Signature) Rece y na a �}d „ �} l � D(i J� O w Date[Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) } Date/Time <br /> Dispatched by (Signature) DatelTlme Received for Laboratory by 1/ Date/time <br /> Method of Shipment Laboratory Name <br /> Special Instructions I hereby auutthho/?r)i1ze the performan of the above Indicated work <br /> q= i• <br />