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�L Advanced CHAIN OF CUSTODY RECORD <br /> � GeoEnvironmental, Inc. Dace Page 3 of <br /> 837 Shaw Road-Stockton, California-95215- (209)467-1006- Fax(209) 467-1118 — <br /> ClientIA� a Project Manager <br /> /-: (&-Ji� Tests Required <br /> Phone Number I A- <br /> 4-1- 6 q—1006 <br /> Samplers: (Signature) Invoice: <br /> Project Name 12Q Zt70 <br /> v�p� AGE <br /> Client <br /> i <br /> Sample Location Sample Type Date <br /> Number Description Date Time Water Air Solid No. of Conts. OV / Notes <br /> Comp. Grab. <br /> -15 7 as T. II49 I <br /> W-ate I jaul <br /> -a5 I I;Z I X <br /> e,9-3o 1 19-a9 1 AI X <br /> 62-35 i;ZH3- X <br /> 62- 90 130.3 X I ttv� <br /> F)--A_ 4.5 IS-11 x 1 Itr t p • <br /> e i qws a y: ign ture)� ecerve y: ignature Dats/Time <br /> Relinquished by: (Signature) Received by: (Signature) 5 , ( ,/t -i DatNTime <br /> Y'1 r <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) Date/Time <br /> Dispatched by: (Signature) Date/Tims Received orLaboratory by: ; Date rime <br /> Method of Shipment: c 0LaboraName 6AL�A C <br /> Special Instructions: 1 hereby <br /> //a�/autth,o{rriize 7the performance of the above indicated work. <br />