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/ Advanced CHAIN OF CUSTODY RECORD <br /> j� _ <br /> GeoEnviron men tal, Inc. Date 7-3rIP Page or <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 1 1 640 <br /> Client e e0 Z Project Manager <br /> i� LI Tests Required <br /> Phone Number <br /> A5 AW—�- <br /> Samplers: (Signature) Q� Invoice: <br /> `/ �j <br /> Project Name VQ ��DAGE Qr <br /> ��j a Client EJ <br /> Sample Location Sample Type —Fof <br /> Date Time Water Solid / Notes <br /> Number Description Com crab. Air s. -K F=� <br /> via � p ms'µ� � r , <br /> 7 3�8 <br /> WD r '� <br /> e inq is e ( ignalure ec ive y: ignal re � G Date/Time <br /> • ' a 7 4d 4 <br /> & <br /> ,w <br /> Data/Time <br /> e quished by: (Signature) Re ved by: (Signat re) <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Dale/Time <br /> Dispatched by: (Signature) Date/Time Received lot Laboratory by: Date/Time <br /> Method of Shipment: I e iJ? p e tA <br /> AV <br /> aboratory Name <br /> ()1► - V &G METALS O1 �R C <br /> Special Instructions: ICU PRESERVATION1 hereby author) a the performance of the above indicated work. <br /> GOOD CONDITION r <br /> NEAR SPAT QQT77 — r`m•rrr,i�irnC / <br />