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Advanced CHAIN OF CUSTODY RECORD r N <br /> 5 � CD <br /> =- GeoEnvironmentai, Inc. Date Page of N <br /> CD <br /> 837 Shaw Road- Stockton, California- 95215-(209)467-1006-a"ax(209)467-1118 �� Q �� w <br /> ClientAProject Manager <br /> �l L/ Tests Required <br /> 00 <br /> 00 <br /> Phone Number <br /> Samplers: (Signature) Ifri ice: p <br /> c" <br /> Project Name s� L ' AGE ' <br /> Client ❑ <br /> Sample Location Sample Type <br /> Date Time No. of (� 1 Notes <br /> Number Description Water Air Solid GoMs �� <br /> Cornp. Grab. <br /> 93-I cl ��3 �3 � '� I y- <br /> D <br /> G) <br /> frl <br /> <n <br /> O <br /> C) <br /> O <br /> Z <br /> /e✓�l�iw <br /> �ngs ed y' Signature} ecewe y: tgnaSun /AJOate(Time <br /> Relinquished by: (Signalure) Received by: (Signature) �� �— Date/Time <br /> Relinquished by: (Signature) Recelyed by Mobile Laboratory for lield analysis: (Signature) Datefr1me <br /> Dispatched by: (Signature) Daleffime Received for Laboratory by: Date/Tlme <br /> Method of Shipment: ' l� Lebo at Name / <br /> 6 ("OIL m <br /> Special Instructions: I hereby authorize the performance of the above indicated work. <br /> 03 <br />