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Advanced <br />GeoEnviron men lal, Inc. <br />4005 North Wilson Way - Stockton, California - 95205 - (209) 467-1006 - Fax (209) 467-1118 <br />105 <br />CHAIN OF CUSTODY RECORD <br />Date -� -}0-7q- Page I of I <br />I <br />Client K NQ I c(0011 D7 Wlq(�o <br />Project Manager <br />P h j� �; b 6� <br />Tests Required <br />Phone Number <br />zoq • q6 -Z- 1006 <br />Samplers: (Signature) <br />Invoice: <br />Project Name &cI 5 i 6 ro c t w X <br />/ �`'t� �� ��h <br />Client <br />Sample Location <br />Number Description <br />Date <br />Time <br />Sample Type <br />No. of ,' "� ��� <br />� e� <br />__Water Air Soled Conts. <br />Notes <br />Com. Grab. <br />p <br />I <br />hAw..N W. --d pl 1doK S / <br />2'jts <br />6: r <br />X <br />C/ <br />P �- <br />V ifiollc}, w. ,KSI <br />3 r <br />10;30 <br />X <br />( <br />X <br />x <br />P <br />5 • j f'a„� r 1M. -► µc� � ly <br />l0— <br />P`ti-hc( <br />Vor!(t:1. ,nc-( <br />( 1:0 <br />Wee rnqurs a y: ( i g n ap,re) <br />eca by-,-- <br />ignature) <br />D le/Tim <br />� <br />26' 'Xtic 14 <br />`' �.�� <br />`i a / d 2) L <br />Relinquished by: (Signature) <br />Received by: (Signature) <br />D le/Tin e <br />Relinquished by: (Signature) <br />Received by Mobile Laboratory for field analysis: (Signature) <br />Dale/Tima <br />Dispatched by: (Signature) <br />Date/Time <br />Received for Laboratory by: <br />Dale/Time <br />Method of Shipment: <br />Laboratory Nam <br />A 1 (,d <br />041 It cq <br />Special Instructions: <br />I hereby authorize tht perforrnance of the above indicated work. <br />