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( Advanced CHAIN OF CUSTOD RECORD <br /> --- GeoEnvironmental, Inc. �� Date -'d Pnf <br /> 637 Shaw Road - Stockton, California-95215- (209)467-1006- Fax(209)467-1118 <br /> ClientSpw C"-C"L Project Manager Tests ReQ. u red <br /> L t�iti1 <br /> Phone Number <br /> 7SIe ignat e) invoice: <br /> AGE -NT <br /> Project Name u,.L �( �— , <br /> I.1�Gi[1L t� <br /> Client ❑ <br /> Sample Location Sample Type No. of <br /> Number Description Date Time Water Solid v d. <br /> Comp. Grab. Air Conts.4PI -5 <br /> Cv-r of a <br /> F v <br /> y: gnature DatelTl e <br /> Relinquished y: (Signature) Received by: ( Si nature) t)a Si al *� <br /> lTlme <br /> Relinquished y: (Signature) Received by Mobile Laboratory for field analysis:(Signature) 5 1 A . r. DateJTlme <br /> Dispatched by: (Signature) DalelTime Receive for borat ry by: Date/Time <br /> 11 AJ f� �+J l 1lI OTHER <br /> Method of Shipment: OAS Ugll METALS OTHER 1-a orayto(ryyN/�a�m�e p <br /> G L...�- GJ✓ [1 Als1 r�l� Ot /.t"t_Imo` t �t� <br /> Special Instructions: <br /> �OC CIvt11TIUlY ��� Cj =A I hereby authorize a perfar ante of the above indicated work. <br />