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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date 6Page ` of� <br /> of Nn+7hr771 C011f01711(1 <br /> 1603 West March Lane, Suite A Stockton California 95247 (209)956-0264 Fax(209)956-0700 <br /> ClientCp S 5 Project Manager o�S�YKC��O �jevlMtj4fbbt Tests Required <br /> Phone Number / <br /> (7-0q) (15.6 -0;-6 q <br /> Samplers (Signature) 1Invoice <br /> Project Name DSS CoLi Ji-(t -l' 04 XW-; - 7 ,G)W� AGE <br /> y <br /> Client EJSample Location Sample Type No of <br /> Number Description Date Time Water Air Solid Conts Notes <br /> comp Grab / <br /> 55 - 1 Sou? 4KU , svyT51,C ,rl Cor, �srItL3- 1 <br /> i <br /> Cb,�Poyr�fi f-[' 1 <br /> 55 � y X r r <br /> e inqurs a y (Signature) ece y rgnaturP DateT'71'16 <br /> - G-�4 - y� W, [ G4(� re: hr, pr �1 lir- ,r ' as- x( b ti-'1 - U <br /> Relinquished by (Signature) rved by (Signal re) Date/Time <br /> Rehngwshed by (Signature) Received by Mobile Laboratory for field analysis (Signature) �g(TI r �` DatelTtme <br /> Dispatched by (Signature) Date/Time Received for Laboratory by Date/Time <br /> Method of Shipment Laboratory Name <br /> CA-OVEP-M&Ar- &4z ifeetied 661eal�- t <br /> Special Instructions I hereby authorize the performance of the above indicated work <br /> MEMOc <br /> APPRnpum <br /> I i:F'At;E ABSENT C0t4TA1t EF I <br />