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s sr_ � i_ fid fffi! � � � � Illlllllllll! Il• i>• I♦ _1♦ <br /> ( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date /_Z/1-4/slPage 'Z of <br /> 837 Shaw Road-Stockton, California-85215- (209) 467.1006- Fax (209)467-1118 <br /> Client <br /> — Pr ect Manager <br /> Tests Required <br /> Phone Number <br /> 19 n <br /> Sam ers: ( nature) Invoice: <br /> Project Name AGE ❑ <br /> Client <br /> Sample Location Sample Type <br /> {Number Descript on Date Time Water Solid No. of Notes <br /> Comp. (arab. A4 Gont$. <br /> 16 3 A x <br /> 17 <br /> MW <br /> 1 z-�z^Jz Q f <br /> CK, <br /> ~ <br /> y <br /> � A VO <br /> nuTs1, <br /> =15quisty: <br /> lure <br /> eceive y: gnalure <br /> ate/Tlme <br /> Relinquished by, (Signature) Received by: (Signature) <br /> 0ate/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) <br /> Date/Time <br /> Dispatched by: (Signature) oatefTfrne Received far Laboratory b <br /> alerli <br /> Method of Shipment: ab f ory ame <br /> M VA <br /> 6peclallnatructions: <br /> I hereby autho ize the performance of the above indicated work. <br />