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Advanced CHAT O CUSTODY RECORD <br /> GeoEnvironmental, Inc. <br /> Date Z �� Pa$e 2-_ <br /> -' <br /> of <br /> 837 Shaw Road - Stockton California- 95215- (209) 467 10013 - Fax (209)467-1118 <br /> NL <br /> ClientJli) <br /> Pro e Ma ag <br /> Tests Required <br /> Phone mb <br /> uer <br /> 0 1Q© <br /> s (Son ture) Invoice <br /> Project Namt6 - <br /> k, <br /> AGE <br /> CA wke-., Client ❑ <br /> SampleLocation Sample Type No of <br /> NumberDescription Date Time Water Air S°IICi Conts Notes <br /> Comp (arab <br /> , qi 101 <br /> U a3 `r 1 2 �r <br /> « 3 <br /> e ss e y �ign ure Received by sgna(ura) l0 ta/Time <br /> Relinquishe, nature) Received by (Signature) Date/Time <br /> AA W I 11QTAL11 I MM <br /> Relinquish A"1topW,. S eceo r field analysis (Signature) Dale/Time <br /> RM SPA M AA�$13r- CONTAMM 1 <br /> Dispatched by igna ure Date/Time lReceived for aboratory by f] te/Tlme_ <br /> Method of Shipment Cabo tory Name <br /> Special nstructibns 1 hereb orize the formance of the above lndscated work <br /> e� fed- C& ova, <br />