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I-._..r_� 1':•:V:ti•'• ..---�-� �"�J �—_�r..0 ` 1L':i 4'-S '::Y l_�.�:: \i..a�.. i+_..�. �__�__u �+�_, ��____ ___ <br /> ( Advanced CHAIN O CUSTODY fECORD <br /> �:.:..-.moi......-.. <br /> GeoEnvironmental, Inc. Date Page l of <br /> -'` 4005 North Wilson Way-Stockton, California-95205-(209)467-1006-Fax(209)467-1118 Z <br /> cc-Client / Project Manage <br /> ev�� �` C� Tests Required <br /> Phone-Number <br /> Samplers: (Signature) Invoice: <br /> Project Name ����� (�{�,��, / y�f] ,� AGE ❑ -_ <br /> Sample Type <br /> Sample Location <br /> y Client <br /> Date Time Water Solid No. of Nates <br /> Number Description Air Conts. <br /> Comp. Grab. <br /> Relinquished by: (Signature) d (Sig ' <br /> LO) <br /> Da /Time <br /> wo�t_� ! <br /> Relinquished by (Signature) Tie eive by: (Signature) DalelTi e <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Dale/Time Received for Laboratory by: DatefTime <br /> Method of Shipment: Laboratory Name _ <br /> t t <br /> Special Instructions- t hereby authorize the performance of the above indicated work. <br />