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4, Ad danced <br />GeoEnviron mental, Inc. <br />4005 North Wilson Way - Stockton, California - 95205 - (209) 467-1006 - Fax (209) 467-1118 <br />CHAIN OF CUSTODY RECORD <br />Date - -j -� o -q q Page 71 of - Z -_ <br />ClientProject <br />K �4 Ootn <br />- <br />Project Name <br />— <br />Sample <br />Number <br />0 In wtavt <br />Location <br />Description <br />-- <br />-- ----- <br />Date Time <br />Manager <br />1�f v; vl M c f� r Tests Required <br />Phone Number <br />2t o q • 46-7- 1006 <br />Samplers: (Signature) ' Invoice: <br />0 <br />`, AGE <br />�t%(� o� Client ❑ <br />Sample Type <br />Noof <br />. <br />Water Solid �l�b� Notes <br />Comp. Grab. Air Conts. <br />e�1nqursb_e y: ( rgnature <br />Receeqy:(Signature) <br />Da a/Tim <br />Relinquished by: (Signature) <br />Received by: (Signature) <br />D ta/Ti e <br />Relinquished by: (Signature) <br />Received by Mobile Laboratory for lield analysis: (Signature) <br />Dale/Time <br />Dispatched by: (Signature) <br />Date/Time <br />Received for Laboratory by: <br />Date/Time <br />Method of Shipment: <br />Laboratory Name j <br />Special Instructions: <br />auulhorize the pperformance <br />I�herebby, % <br />u <br />of the above indicated work. <br />