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j Advanced ,� -? CHAIN OF CUSTODY RECORD <br /> _ L,-" Date i i-Z'9 -2 Page �— of <br /> : GeoEnvironmental, Inc. <br /> 837 Shaw Road - Stockton, California-95215 - (209)467-7006 - Fax (209) 467-1718 <br /> Client p Proje�yct Manager Tests Required <br /> AI I �-c Icly 17r+ <br /> Phone Number <br /> Samplers%: (Signature) Aa— Irwoice: <br /> GE Jkr <br /> (�L/ �✓ 3 Alen <br /> Project Name � �, Client � <br /> I � t �'� '�=� �/� I rJ Sly'�T� � � 3 —i <br /> Sample Type / <br /> Sample LocationDate Time Water Solid No. of C �� / Notes <br /> Number Description Camp. Grab. Air <br /> Cents. <br /> U— i) -ZS } 12-5 2 X � k( y <br /> V-9 1'3 i I- <br /> 140 <br /> I 1` /` <br /> V-61 140 /X 1 X X <br /> nature Receivedy: ignaWre Date/Time <br /> ehnqu y: 1g ' <br /> "'t Dats/Tims <br /> Relinquished by: (Signature) Received by: (Signature) <br /> t�r r I i <br /> Relinqui by: (Signature) Received by Mobile Laboratory tar field analysis: (Sigpitu ) Date/Time <br /> c <br /> Date/Time flacaiw tof at by: _., j Date lrime <br /> Dispatched by: ISignature) _ / //. <br /> �✓ G(. �f <br /> t -Laboratory Name_ <br /> Method of Shipment: CCAi J f Jv1,� <br /> l �1 tile'r�i 5�l <br /> I hereby authorize the performance of the above indicated work. <br /> Special Instructions: <br />