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Advanced CHAIN OF CUSTODY RECORD <br /> _ Date 2-/0 *7- Page ! of l <br /> GeoEnv�ronmenCal, inc <br /> 837 Shaw Road - Stockton, California- 95215 - (209) 467-1006- Fax (209) 467-1118Q, <br /> Client L � Project M,►na er <br /> Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> Project Name 'Il �� LAGE <br /> C ' ( �'� Client ❑ <br /> p <br /> Sam ie Location Sampie TypeDate Time Water of ,(� <br /> Number Description Water Air Solid Conts Notes <br /> Comp Grab <br /> x i <br /> r�~ <br /> 4 <br /> e inqu e y (Signature) Received by (Signature) Datefrime <br /> Relinquished by (Signature) Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time c d for Laborato y Date/Time <br /> 111 9 'vo <br /> Method of Shipment , Lab atory Name <br /> CAL MCc�,bC>f f <br /> Special Instructions 1 hereby authorize tfi performance of the above indicated work <br /> M � J'1 - 'r k <br /> Y e,ve A .A-1-e -s- I c-4- <br /> i t <br />