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``''.ti.�b� <br /> Advanced GEIS Lam` fir::,,-' :!'. !` `' -. .. -_-... .,,...CHAIN 4F CUSTODY" ECORD <br /> :.' � f � � <br /> _- GeoEnvironmental, Inc, JLAB1 Si'A`�`(:r DIL., , '; Al-. p. .. Date Page of <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax{ p8)467 1119 ""` 5 ``�""'``N v` <br /> Client �� � ? ,� Project Manager <br /> �� 1 Tests Required <br /> L 0,5b Eaw Y- Phone-Number <br /> Samplers: (Signature) v Invoice: <br /> Project Name , �! AGE EJ <br /> Client <br /> Sample Location Sample Type o <br /> Number Description Date Time Water Solid Na- of Notes <br /> p Comp. Grab, Air ContS. <br /> 50354 <br /> CA -45 (4L% <br /> 50355 <br /> Chi 50355 <br /> 865 50357 <br /> 50358 <br /> 0131—iZ) 50359H <br /> L <br /> e mquis a y: rgn ture eceive y: (Signature) Daterrime <br /> I)y <br /> Relinquished by: (Signature) Received by: (Signature) DateJTlme <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date ime �4 <br /> Dispatched by: ignature) Iii i i.rs'_ .� ',i:i+. `'W ,'" Date/Time Received for Laboratory by: <br /> i Date/Time <br /> .U10-Aw Z <br /> r � Laboratory Name <br /> i i- <br /> ti. ..fat. p <br /> i. :h :- „Ai fit j(,[',r- •�k:-"ri i^.I"IR�. <br /> ., Old C_ <br /> Special Instructions: ',\ F� I hereby authorize t e performance of the above indicated work. <br />