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'h CHAIN OF CUSTODY RECORD <br /> Advanced _to <br /> GeoEnvironmental, Inc. Date `� Page A- of <br /> 4005 Norlh Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467.1118 <br /> cj Ekoou. <br /> Client Project Manager <br /> K{ ± M c K% b Tests Required <br /> Phone Number <br /> (�09) 4 6 7-loOG <br /> Samplers: (Signature) Invoice: <br /> fn .�I�t�/U �✓' '\ AGS <br /> Project Name l 4 t,W-f KA Xv� Client <br /> Sample Location Date Time Wafer Sample Type Solid No. of ��` Notes <br /> Number Description Air ContS. <br /> Comp. Grab. <br /> F �7 -� z =�y X X <br /> -37 <br /> Relinquished, y: ( ignature) Received by:'(Signalute) Date/Time <br /> Relinquished by: (Signature) Received by: (Signature) DaletTime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Datefrime <br /> Method of Shipment: Laboratory Name J <br /> GII t7U��hi +� 1 llc �A�t/I �{ � 1 <br /> Special Instructions: P�[SE��/`rro `IU I hereby authorize the performance of the above indicated work. <br /> GOOD CO�,h�� 1 <br /> UI <br /> HEAD SPACE ASSENT <br /> CONTAIN <br /> � 11� � � fI111111i � 11111111111■ � � t>i � � t>• � � tl• � tl• (11111111. <br />