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3i <br /> Advanced f CHAIN OF CUSTODY RECORD <br /> GeoEnvironmentai, Inc. <br /> Date 6 Page of <br /> B37 Shaw Road- Stockton, California- 55215- (209)467-1006- Fax (209)467-1118 <br /> Client PMCt Manag r Tests Required <br /> P o Num r <br /> OC 'Vt <br /> Srs ( ig ure) Invoice <br /> Project Name L0Gam- ( V-6' AGE <br /> jR- <br /> 1/1'� U <br /> Client ❑ <br /> Sample Location Sample Type No of <br /> Date Time Water Solid Notes <br /> Number DescriptionDate <br /> Grab Air Conts <br /> 047 <br /> ew c r AFI 3 Y <br /> Relinquished y Yei Nocerve y ignalure Date/Time <br /> Relinquished by (Signature) Received by (Signature) 7- A Date me <br /> Relinquished by (Signature) Received by Mobile Laboratory for flaid analysis (Signature) Date(fime <br /> Dispatched by (Signature) Date/Time Received f a rator D to/Time <br /> Ing <br /> Method of Shipman Laboratory Name <br /> co, PI�L- <br /> Special <br /> Instructions I hereby auth r ze he perform o the above indicated work <br />