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( Advanced CHAIN OF CUSTODY RECORD <br /> k. GeoEnvironmental, Inc. <br /> Date �1 �3 Page of <br /> 837 Shaw Road- Stockton, California- 95215- (209)467-1006 -Fax (209)467-1118 ()9_,Q ?0 <br /> Client �. OJW i a J4— P ect Manager Tests Required <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> Project Name <br /> ¢ AGE,E�:- <br /> '� Client <br /> Sample Location Sam a Type No. of <br /> Number Description Date Time Water Solid ££ f1r Notes <br /> p Air ContS. <br /> Comp. Grab. <br /> Rel, u's a gnature Receivedy: (Signature) DatelTime <br /> inquished by: (Signature) Received by: (Signature) Datefrime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) Date/Time <br /> Dispatched by: (signature) Date/Time Received for Laboratory by: DatelTime <br /> -I <br /> L.a <br /> Method of Shipment: Lebo ry <br /> Special Instructions: authorize the performance of the above Indicated work. <br />