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l Advanced CHAIN OF CUSTODY RECORD <br /> of <br /> _ --, GeoEnvironmental, Inc. Dace Paye <br /> ` 837 Shaw Road -Stockton, California- 95215 -(209)467-1006- Fax (209)467-1118 <br /> t-� Pro/ject Mier Tests Required <br /> Client I,t�ti Ct hu 1 Gf j G a u,tl ��c. L i✓U r :. <br /> Phone Nu ber <br /> '2 /7 Irl t6, <br /> Sam lers: (Signature Invoice: <br /> N�. C3 <br /> Project Name �r 1" �� 5 ��`� ✓��' �� � C Giem ❑ <br /> er k 'V � c� hd i �1• <br /> Sample Location Sample Type of <br /> No. <br /> Number Description Date Time Water Air Solid Conts. '��4�ti Notes <br /> Comp. Grab. <br /> -Rel inq is a y: ( 9 a re Received by:79rg—ne—Pe-F Date ime <br /> Relinquished by: (/Signature) Received by: (Signature) t� �/ Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) Date/Time <br /> Dispatched by: (Signature) Date/time Received for aboratory Date/Tlm <br /> Method of Shipment: L oratory Name <br /> C ,� L 1 CCN <br /> Special Instructions: r 1 herebi authorize the.Qerlbrmance of the above indicated work. <br />