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j L Advanced <br />GeoEnviroil mental, Inc. <br />4005 North Wilson Way - Stockton, California - 95205 - (209),167-1006 - Fax (209) 467-1118 <br />CHAIN OF CUSTODY RECORD <br />Date � -1r) -q Page -1` of Z <br />Client K �a � � Do+n <br />Project Name t S <br />Sample <br />Number <br />0 � In wta <br />( a S <br />Location <br />Description <br />vl <br />G N D a <br />Date <br />Date Time <br />, t Project Manager Tests Required <br />1��v►V, M IC;I►`r� <br />Phone Number <br />coq- W67- 1006 <br />Samplers: (Signature) ./ Invoice: <br />a <br />7G�,�^• MIA � AGE N <br />��� Client n <br />Sample Type <br />. Nof <br />Water Solid /�: �� Notes <br />Comp. Grab. Air Conts. <br />e ngws ad My: �(S�ignatur_e)/ <br />rise�Vy:(Signature <br />Dale/Tim <br />Relinquished by: (Sigoaturo) <br />floceivod by: (Signature) <br />Dite/Tinle <br />Relinquished by: (Signature) <br />Received by Mobile Laboratory for field analysis: (Signature) <br />Date/Time <br />Dispatched by: (Signature) <br />Dale/Time <br />Received for Laboratory by: <br />Date/Time <br />Method of Shipment: <br />Laboratory Name <br />A l kq N 41 1 j Gq I <br />Special Instructions: <br />I hereby authorizethe performance <br />gtt <br />of the above indicated work. <br />