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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc Date Page I of l <br /> 837 Shaw Road - Stockton, California- 95215 - (249)467-1006 Fax (209)467-1118 <br /> Client Project Manager <br /> Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> i <br /> Protect Name AGE <br /> Client ❑ <br /> Sample Type <br /> Sample Location Date Time Water Solid No of Notes <br /> Number DescriptionComp Grab Air ContS <br /> u 4�0 METALS <br /> ICEIt' PRESERVATION <br /> BRADS ACE ABSENT CONTAINERS <br /> DECRY RINATED IN LAB PRESERVED IN <br /> eLnquisLh�e y ( ,gnat re) eceive y ignaiure 1 Date/Time <br /> Rel+ quis ed 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 Received for Laboratory by Date/Time <br /> Method of Shipment � labo�X- <br /> m be ff <br /> Special Instructions I hereby authorize t e performance of the above indicated work <br />