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j AdvancedCHAIN OF CUSTODY RECORD <br /> 3-Cis Page at <br /> GeoEnvironmental, Inc. <br /> 837 Shaw Road-Stockton,California-95215-(209)487-1006-Fax(208)467-1118 <br /> Client t2;skv. ;w S4�uscs h P M � TOM <br /> kv4 � <br /> Phone Number <br /> �� �Irr _j bviv <br /> Samplers: (Signature) C Invoice: <br /> AGE <br /> ProjectName 0. e Client ❑ <br /> Sample Location ample Type Solid No.of .tr' h / Notes <br /> Number <br /> Description Date Time Water Air Conts. <br /> Comp. Grab. <br /> *6--2- 2 13-1- a -z-L; w01& <br /> 5,-3 -5 S-1!>C 5' It's if <br /> 6--5,_.I0 it 'o r <br /> Date ime <br /> mquis • y: ignature Received nature <br /> u n <br /> �'•�,�_ �"' i.a Dat /Tkne <br /> Relinqfflshed by: (Signature) Received by: (Signature) T <br /> Relinquishedy:(signature) Received by Mobile Laboratory for field analysly,( e) <br /> DatelTime <br /> Date imejft��rate/Tbne <br /> Dispatched by:(Signature) i <br /> Method of Shipment: Laboratory Name <br /> CAt— Ter-0 <br /> r_-S� �,,,�: 1� I ; p altcoL Lok 1 hereby authorize the performance of the above Indicated work. <br /> Special Instructions: $24.0u SS&Vk "� � ", , `� e.tp Py ! <br /> u!I <br /> r rnv �+tSi�`J :,tear- C% W- <br />