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j CHA <br /> Advanced I O CUSTODY RECORD <br /> GeoEnvironmental, Inc. Dace` Page 2 of <br /> 837 Shaw Road - Stockton, California- 95215- (209)467-1006 - Fax (209) 467-1118 (0 — 07 ? <br /> Client c Z Proj Manager <br /> T Required <br /> Phoneum�b�er <br /> Samplers: (Signature)ig re) ��� Y Invoice: <br /> Project Name �U � b �j , G )) p ,w AGE <br /> l `-e- �` �C' Client ftah <br /> Sample Location Sample Type No. of <br /> Number Description Date Time Water Air Solid Conts. Notes <br /> Comp. Grab. <br /> 43- <br /> ry <br /> 3- 1 113 1 �o <br /> 3-ZD ►I 1 <br /> 3- 25 16 X ) A <br /> 1k✓ [ L� X x <br /> ts/Tima d5 <br /> 630 <br /> elinquished by: (Signature) Received by: (Signature) ��� 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: Data/Time <br /> Method of Shipment: Laboral amen ,r n p <br /> C U4 r _' C- L Ll( <br /> Special Instructions: 0 4` j/r I hereby <br /> /–/'fauthorize the performance of the above Indicated work. <br />