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Advanced <br />GeoEnvironmenlal, Inc. <br />4005 North Wilson Way - Stockton, California - 95205 - (209) 467-1006 - Fax (209) 467-1118 <br />CHAIN OF CUSTODY RECORD <br />Date L 13 9 Page I of �L <br />Project Manager <br />Client K (} docit', vh 14{ w, 11"' i b U 4 h Tests Required <br />Phone Number <br />OLOq)q67-too 6 <br />Samplers: (Signature) / Invoice: <br />AGE <br />Project Name 1 v <br />I'� S (� a s �- (� r o c • M � Client � <br />Sample Type <br />Sample Location Date Time Water Solid No. of -f Notes <br />Number Description Comp. Grab.Air Conts. <br />i <br />LASTS North • 4 ��t <br />-I�-qB' <br />Il=`fg <br />�_ <br />/1 <br />r <br />✓ <br />_ <br />�rJ " ' `� — <br />T <br />Uq No.lh• ►3' <br />_ <br />1 7;s8 <br />_ <br />X <br />l <br />✓ <br />T%- L <br />eeni�r 13*� <br />Il:s1 <br />T3 -W <br />s»„f( uf7, W fT•,d P. <br />1 7' 10 <br />/\ <br />iielingws a (Sign lure <br />Rece a y:(Signature) <br />Date/Time <br />Relinquished by: (Signature) <br />Received by: (Signature) <br />I <br />Dale/Time <br />Relinquished by: (Signature) <br />Received by Mobile Laboratory for held analysis: (Signature) <br />Dale/Time <br />Dispatched by. (Signature) <br />Date/Time <br />Received for Laboratory by: <br />Dale/Time <br />Method of Shipment: <br />Laboratory Name <br />A Iy6g <br />I <br />Special Instructions: I I hereby authorize the performance of the above indicated work. <br />