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Advanced CHAIN OF CUSTODY ECORD <br /> - Date 5 ` Page 2 of � > <br /> GeoEnvironmental, Inc. <br /> 837 Shaw Road-Stockton,California-95215 - (209)467-1006- Fax (209)467-1118 � � - <br /> 22 <br /> Client Project Manager V <br /> cd— ��Q G-54'%4"K- Tests Required <br /> Phone Number <br /> LUCI) q0-1644- <br /> Samplers (Signature) y Irnace <br /> N. AGE <br /> Project NameTa-c;C'L �ye � ikr� Z� � Client"❑_ <br /> Sample Location Sample Type Date Time Water Solid No of Notes <br /> Number DescriptionCompGrab Air Conte �V <br /> OWS/oNS4 X141 G Lal,wirAlt 17,30 .1-00* 3 <br /> Relinquished e y (Signature) Receivedy (Signature) ClatelTim <br /> 9 (fey. <br /> '1 -(7 /#0 <br /> Rellrouished by (Signature) Received by (Signature) Date ime <br /> Relinquished by (Signature) Received by Mobile Laboratory for heed analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Received for Laboratory Date/Time <br /> Method of Shipment L calory Name <br /> Special instructions I hereby authorize the performance of the above Indicated work <br />