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:..� �.. t� t>.wll■! tip � I• � � � � � � � <br /> ( Advanced CHAIN OF USTODY RECORD <br /> GeoEnvironmental, Inc rVy3,d31 I(P Date w-itj— Page of <br /> 837 Shaw Road Stockton, California-95216- (209)467-1006- Pax(209) 467-1118 <br /> Client 4C, C A Pr Aanager <br /> Tests equlred <br /> Phone Number <br /> �90 1 )16 7 /00(o <br /> ::E7 <br /> lers (Signature) �/ Invoice,AGE <br /> Project Name / <br /> ta�� � � <br /> Client ❑ <br /> Sample Location Sample Type , <br /> Number Description Date Time Water Alr Solid No Conof Nates ? <br /> comp {arab <br /> W,q (3� 7 <br /> UJI11A a32yd <br /> KOM hed +gnature 'No ce+ve y gna;ure <br /> 0 o'Trme <br /> Relinquished by (Signature) d <br /> ' 4 Received by (S�g atura) ate�T[me <br /> Rehnqulshed t )OV na r VAS Recer o I!a Labo ator far eld analysis (signature) <br /> + 'tOD C{�I'iL f'"in*I_ P1 Ro011 Date/Time <br /> ti <br /> D+spetchad byx( jfy tuce�wi U �18L...��Y# iIFiVF:I3 � � Date/IIme Re r La oratory by PVrate/T!ine <br /> Method of Shipment <br /> l. 2� <br /> R t/- Laboratory Na <br /> 4!:�/ e <br /> e✓ <br /> Speci ! Instructions /"C' <br /> I hereby uthorize the performance of the above Indicated work <br /> � Geigy Sia lr}�ce 7Co ref <br />