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�A'A Advanced <br /> CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental Inc. %�i > Date�� �� Page I of---.1— <br /> �! 837 Shaw Road - Stockton, California - 95215 - (209) 467-1006 - Fax (209)'467-1118 <br /> Client Projectanager Tests R <br /> — I_✓) /� equired <br /> I Y1Phone Number <br /> Samplers: (Signature) Invoice: <br /> Project Name _ j / / / AGE= h� <br /> Mooj 1 R d 4'f.ce 6&,14 Client <br /> Sample Location Sample Type No. of �-��� � / / / <br /> Number' Description Date Time Water Solid i �7y j �� ! ;'� Notes <br /> p Comp. Grab. Alr Conts: ! <br /> -> > 4� gv 89606 <br /> 0-7 <br /> F ; - �f <br /> �. S 89608 <br /> i'^fir® � P1 �AiAi; P1 <br /> —Rei shed y: (S+ ntrr Receivedy: (Signature) � .�rC — <br /> Data/Time <br /> 9 <br /> Reli quished by: {Signature) Received by: (Signature) Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis. (Signature) 0ate/Time T <br /> Dispatched by: (Signalure) Date/Tlme Received for Laboratory by: f]ate/Time <br /> Method of Shipment: Laboratory Name <br /> Special InstFuctions: I hereby authorize the performance of the above indicated wurk. <br /> ��(I;Calre-C c' I v�'_d e-(,- lE'_C�I "k <br />