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( Advanced CHAIN OF CUSTODYLL RECORD-_ <br /> Date U'S 1601 page L ofd <br /> GeoEnvironmenxal Inc. <br /> 4005 North Wilson Way-Stockton,Califomia-95205•(209)467-1006-Fax(209)467-1118 <br /> Client Project Manager Tests Required <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> l 1 D# / AGE �. <br /> Project Name � <br /> S �v �(�, Client ❑ <br /> C" J 40 <br /> �� C7 <br /> Sample Location Sample TNoat D <br /> Date Time Water Solid . Z Notes <br /> Number Description Comp. arab. Air Cants.Comp. i <br /> . 3 <br /> /,0 (&U i t�3►(>ro l iZzi i <br /> rl1rZ�d3 i U <br /> o34c�vi 11;SS � <br /> 6-339 <br /> - <br /> �5 <br /> e us a y: [ ignature Received by!(Signature) Date/Time <br /> 031loo 1 <br /> Re in r <br /> ished by: (Signature) Received by: (Signature) I'll O�tG OTHER Date/Time <br /> +• `f PRESERVATION <br /> Relinquished by: (Signature) Received by Mobite Laboratory fo/,fip♦,¢r¢s�ypMn e) PROPRIATE Date/Time <br /> . - 177VQn Vv�ruiill�t <br /> Dispatched by: (Signature) Date/Time a eav a ardtvey'byI ,il,�' DatelTime <br /> 1 r'T <br /> l� %J:� 0.r ;% ✓ j ' :.,✓_ -1 <br /> /� <br /> L <br /> Method of Shipment: �� Labofaty flame <br /> •I-t <br /> C a QVe-ryl t '-t r <br /> Speciai instructions: 4 hereby thorize the performance of the above indicated work. <br />