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r!ar <br /> 0 <br /> CHAIN OF CUSTODY RECORD <br /> Advanced Date I U Page – <br /> —L otA-- <br /> �, <br /> ;� '' GeoEnvironmental, Inc. <br /> , � _ <br /> F; `; ' ;; <br /> ��� 837 Shaw Road -Stockton,California-95215- (209)467-1006- Fax(209)467-1178 <br /> ` C Pr ' ct Manager Tests Required <br /> Client � e9 <br /> Phone Numnbgr <br /> � /invoice: <br /> _ Samplers: (Signature) Q p� <br /> AGE <br /> Project Name r V f -V Gf ant ❑ <br /> Sample Location Sample Type No. of Notes <br /> Solid <br /> Number Description I Date Time Comp. Grab.Water Air Conts. ;-%� �' / <br /> UT -7S <br /> UT-I13 tit 6e v qvo132(bK --- <br /> T ., -- )- e,r <br /> tj�`nLlT --60 75©I <br /> Re ngwshe y: ( .gnature) eceive y: igna(ure <br /> Date(rime 4F <br /> mquished by: (Signature) Received by: (Signature) <br /> Date(Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) <br /> '4t <br /> Dispatched by: (Signature) Date/TimaReceived lot LabLaboratory by: DataRime <br /> Method of Shipment. Lab-1117 Name <br /> C7\li� I" F}� ia L "�EC — <br /> Special Instructions: _ areby authorize the performance or the above indicaled work. <br />