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-- i • • <br /> ( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEttvirottmental, Inc <br /> Date (Z– C t"3 Page — I <br /> of <br /> 837 Shaw Road- Stockton, California -95215- (208) 467 1006 - Fax (209)467-1118 <br /> ClientF'Gt(. [.�.n <br /> — Project Manager <br /> t�r � I��� �-C� TestsR oared <br /> o, bc)�S-U�, <br /> Phone Number <br /> 467 - fU� <br /> — -- _ Sa er (Signature) Invoice <br /> Project Name AGE JR <br /> cxC t + C [ a-,\ 4 e �✓ U V Client ❑ <br /> Sample Location Sa ple Type <br /> P Date Time N0 °t ' 4.� 'V Notes <br /> Number Description Water Air Solid Cants /C �'' <br /> Comp Grab x <br /> ;t5 14 Li 0c)3 1�4)��� ( ' <br /> _ � K <br /> -i`" '3 Irl X\ �C <br /> Icive <br /> GOOD 11 ♦nnan car <br /> BEADS ACEASSI.N1 CONIAINLRS--:�� E7CID S ALED 81INT!1V AG+ tffp <br /> DECtiL(RIPIAILI]IN LAB---PltF91 PVEF)IN L^ _u__ Y l t <br /> T— <br /> s a y ( ature acs ve y rgnature Date/Time <br /> 11 <br /> eI nq.,rh.d by {signature} Received b Sr natur© <br /> Y ( 9 ) Date im <br /> Relinquished by (Signature) Received by Mobile Laboratory for held analysis (Signatufe) DatalTime <br /> Dispatched by (Signature) Date/Time Receivod for Laboratory by , Da1e(Tima <br /> Method of Shipment )(J Q[ Laboratory Name T <br /> f',-%-1- - cV4 +" <br /> Special Instructions 1 I hereby auth rize the parfarmance of the above Indicated work <br />