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�,,i• � � i• � i• � 1, � �� tib �■ <br /> Advanced CHAT I CUSTODY RECORD <br /> --_ GeoEnvironmental, Inc. <br /> Date Page o� <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> 3 <br /> Project Manager <br /> Client w t� �� Tests Required <br /> via L <br /> Phone Number <br /> u Zdq yto`t�i do Ca j. y <br /> Samplers var Invoice. <br /> / i ` AGE A <br /> Project Name J Client ❑ <br /> Sample Location Date Time Water Sample Type Solid Na of Notes <br /> �► <br /> Number Description Comp r Air Cants t <br /> LA <br /> 171 9 <br /> Islak <br /> 1 ZO7 X YX <br /> 17 Q <br /> V. 15- t 17171 f <br /> e in e y to ece ve y ignature /3 q� DatelTlma . <br /> ,7 a• s-rn. � A • <br /> Re rnquis e y (Signature) Received by (Signature) ata/Time <br /> Rellnqulshed by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date rime <br /> Dispatched by (Signature) Dale/Time Received for Laboratory by DatelTime <br /> Method of Shipment Laborat r Na <br /> rT A-At <br /> Special 1 0ans. 1 hereby authorize life performance of the above indicated work <br />