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j Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date lD-( y-t Page –4— Of <br /> 837 Shaw Road - Stockton, California-95215•—(209)467-1006- Fax (209)467-1118 V -0 <br /> r] <br /> Client Gera .� Project fJGf,,,.,_ Tests Required <br /> Phone Number <br /> Zoct- Lf( e)- Ince <br /> Samplers: (Signature) ` \ Invoice: <br /> Project Name11A , � —' ��-- ��ry AGE <br /> � � a� Client <br /> Sample Location Sample Type r� <br /> Number Description Date Time Water Air Solid Co. o >`W Notes <br /> Comp. Grab. <br /> 3 C� <br /> Q3 -1� LL tt @lo lsyo <br /> It t` (O ISIS <br /> z4c_ <br /> 4 <br /> dS-l0 Qo•r < Se- kD 11 11 <br /> e ingm a y: na re) ace`s y: ignalure <br /> Date/Time <br /> 1b-I?-pt{ (�C <br /> Relinquished by: (Si ature) 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: Date/Time <br /> I I Ito— ► cl- ;;:cw <br /> Method of Shipment: C Labors Name � <br /> J�l VV VKL �. <br /> Special Instructions: I hereby authorize the performance of the above Indicated work. <br />