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aoD -- u��r / <br /> I�` CHAIN O� <br /> ,L Advanced CUSTODY RECORD <br /> GeoEnvironmental Inc. Date 16 c� '�'% Page of <br /> 837 Shaw Road- Stockton, California- 95215- (209)467-1006- Fax (209)467-1118 <br /> Client h>Q 0- -�-n c Project Manager <br /> C-61", fnklGr Tests Required <br /> Phone Number <br /> Samplers: (Signature) �� Invoice: <br /> Project Name [,n Ch � � �= AGE ®. <br /> _ Client ❑ <br /> Sample Location Sample ype <br /> Date Time Water Solid No. of <br /> Number Description Air Conts. Notes <br /> A'+1, <br /> Comp. Grab. <br /> Vioo.lal S' C. ' 1, lv c,3c t HT1 L'I X <br /> �aolc>! I O /4 J z i 0'7 3 <br /> el' i ed y: (S gnature) Received by: (Signature) <br /> 5-c (�en 'T` Date/Time <br /> el' uished by: (Signature) Received by: (Signature) (a J T, h1 la.-© Wit) C��} <br /> Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Date/Time <br /> Method of Shipment: Laboratory Name <br /> CAL <br /> Special Instructions: I herebX authorize the performance of the ab ve indicated work. <br />