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• r • <br /> CHAIN OF CUSTODY RECORD <br /> ( Advanced Pa t C4 <br /> _ GeoEnvironmental, Inc. � �*��L <br /> +/ 637 Shaw Road-Stockton, flalllornla B5215-(209)467-1 DD6- Fax (209) 467-1118 <br /> Client ' Pra ct Manage T s Required <br /> t lv� r• <br /> Ph 0IV ber <br /> 416-7 z6v <br /> Sa lers, (Signature) Invoice <br /> J AGE <br /> Project Name � - r�(�`J C[lent <br /> Sample Type No of 6 <br /> Sample Location Date Time Water Solid Notes <br /> Number Description Comp Grob Air Cortts <br /> Relinqui3hed by ignature scans y gnatu►a <br /> atell'ima <br /> �1L <br /> Date/ilme <br /> Relinquished by (&gnaturs) Received by (5lgnatvra) <br /> Relinqu shed by (Signature) Received by Mobile Laboratory for field analysis (Signature) <br /> DatalT ima <br /> Datelfime <br /> Dispatohed by (Signature) <br /> Date rima Receive lorLaboratoryb <br /> Labor or Name � <br /> Method of Shipment <br /> i hereby authorize the Derlormanoe of the above Indicated work <br /> Special instructions <br /> r� <br /> Project 2 89 Page 12 of 12 <br />