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CHAIN OF CUSTO%RECORD <br /> `- Geological Audit- Services , I nc . Date tC� -29"Q5 Page L of z <br /> rbnmenta/Professiona,(s <br /> �7 1803 West March Lane Suite A Stockton California 95207-(209)956-0264 <br /> Client Project Manager Tests Required <br /> r'1Gv ^ o_rG e GQ >nru c - V� Cfne�vp� <br /> Phone Number <br /> Samplers (Signature) Invoke <br /> GeoAudlt <br /> Project Name_�otA rQ G�/ 5 2 r v I L�—5 I ��i e V\ <br /> Client ❑ <br /> — Sample =_ - Location _ Sample Type No ofNotes <br /> Date Time Water Solid Q'Z` <br /> Number - Description — Air Cants <br /> p _ _ <br /> — Comp Grab <br /> Mw -'35 <br /> �rCw *1=�O- <br /> 3p== <br /> - e quis e y ( ijpgure eceive y ignature Date(Tlme <br /> m <br /> r� Relinquished by (Signature) Received by (Signature) <br /> Refmquished by {Signature) Received by Mobile Laboratory for field analysis (Signature) <br /> Date/Time Received for ry byDate me <br /> ` �V� <br /> Method of Shipment -_ Laboratory Name <br /> Special Instructions I hereby authorize the performance of the above Indicated work <br />