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ri <br /> Advanced CHAIN OF CUSTODY RECORD f <br /> --1 _— GeoEnvironmental, Inc. Date -q Page <br /> � -3 — of <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 l` w J1J <br /> Client Project Manager 1 L <br /> > - Tests eed <br /> C b S Phone Number <br /> Samplers: (Signature) ce: \ <br /> )� E <br /> Project Name G <br /> Sample Location /yC[`f Sample Type No. of <br /> Number Description Date Time Water Air Solid Conts. Notes <br /> Comp Grab. <br /> D, P1 I I Ka s <br /> e i u a y: ( ig atur. ecery y: ign r <br /> 'ale ime <br /> KeCU h�' /'v�d/(,c � T <br /> Relinquished by: ignature) Recyived I : (Signature) Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Dale/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Date/Time <br /> Method of Shi mant: Laboratory,Name <br /> ' <br /> Special lnstructior7s7 1 hereby authorize 1 e performance of the above indicated work. <br />