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t t t 1 t ( i t i i t t i t t t oL,CS NcsA5t67 <br /> CHAIN OF CUSTODY RECORD <br /> Geolo( ical Audit Services , Inc. <br /> Date , L� PageOf <br /> E17141�Win--nf Professl3W.& <br /> 1803 West March Lane.Suite A-Stockton.California-55207-(209)856-0261 <br /> r. <br /> Client Morn's Project Manager Tests Required <br /> L}S tJ,. WSi\lyl W( Phone Number <br /> Dog - ys -ori- <br /> � - C4 ���c�S Samplers: (Signature) � 1_ Invoice: <br /> p ( " 21 <br /> Project Name �C��'1'S 01•r�j�j;e �JC"`"`� �"a'1iU-'- b2C.��GLI'c' � �U°40 GeoAudit Clie <br /> �S r-J <br /> Sample Type <br /> Sample Location No.of �r 1xro / <br /> Date Time Water Solid Notes <br /> Number Description comp. crab. Air Conts. <br /> 34505 <br /> 3 L_y.� 34506 �-- <br /> 34507 <br /> S-6 <br /> 3 Z y�� �,: 23 <br /> L_ <br /> 34508 <br /> 1-SSl -4 I <br /> PN --La Z,..Z yy y 34509 <br /> -� 34510 <br /> inquiI a y. gnature -13 ali Received y: (Signa a <br /> LA <br /> Relinquished by: (Signature) Received by: (Signature) _ Oets/Time <br /> Relinquished PRIM a ,py ob le a or eld analysis:(Signature) Date/Time <br /> 1Ut,74 ',raah.. -r <br /> Dispatched by• w CONTfil Date/Time Received for Laboratory by: Date/Time <br /> � fil <br /> Method of Shipment: - Laboratory Name <br /> C M x lm <br /> Spacial Instructions� 2 I hereby authoriz the performance the above Indicated work. <br />