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Advanced CRAW OF CUSTODY RECORD <br /> Date {I7t, age of <S . <br /> GeoEnvironmental, Inc. <br /> 837 Shaw Road-Stockton, California- 95215- (209)467-1006- Fax (209)467-1118 ! <br /> Client <br /> P rood Manager Tests Required <br /> vimIV04.1 <br /> • f v <br /> Phone Number -- <br /> ' <br /> Samplers: (Signature.) 4-, / t��y'� , Invoice, <br /> -- i / ate/ •/ // AGE <br /> Project Name EAh <br /> it �r�; , •1 ..' � ,,. ,. ':. /;'��� ' J`� i Client <br /> r <br /> Sample Type ; ���5 <br /> Sample LocationDate Time Water Solid No. of y % Notes <br /> Number Description Comp. Grab. Air fonts. <br /> I <br /> A!-.3- IC' 7i7h t_ k <br /> i3 - 15 .)134 <br /> i <br /> e mqul a y: Signatur )7 <br /> starve y: rgneture DatefTI e <br /> _ cc <br /> d Dale/Time <br /> Received b <br /> Relinquished by: (Signature) y: (Signature) <br /> Y <br /> Relinquished by: (Signature) <br /> Received D Mobile Laboratory for field analysis:(Signature) DetotTime <br /> Date/Tims Receive or Laboratory fy/'a DatefTime <br /> Dispatched by: (Signature) � - <br /> t.' <br /> Laboratory Name <br /> Method of Shipglant <br /> �'tv"V✓I j't? t1' P "[ <br /> AI hereby authorize the performance of the above Indicated work. <br /> Special Instructions: <br /> i- . <br /> i. <br />