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Advanced CHAIN OF CUSTODY RECORD <br /> Date Page -3-- of 1L__. <br /> GeoEnvironmental, Inc. <br /> 837 Shaw Road - Stockton California- 95215-(209) 467-1006 - Fax (209) 467-1118 { !� <br /> Client C� Protect Manager Tests Required <br /> 7ne Nu bei <br /> )� W -/e 4, <br /> Samplers (Signature) Irnotce <br /> AGE .r�( <br /> Protect Name ` � G � � / Client ❑ <br /> t <br /> pe,- <br /> Sample Location Sample Type Solid No of Notes <br /> Number Description Date Time Water Air Conts <br /> Comp Grab <br /> Rzk �z� ( J 1 k /of - 7; <br /> tw 1*7 � X x <br /> o,3 07 \-7c� ®� xx � <br /> ,>< <br /> I Aw 1�S� <br /> e mqu+s e (S'+gn tire) eceive y ignature Da ITrme <br /> 700 <br /> Rel quashed by (Si natur Received by (Signature) tit}}�� atelT me <br /> Relinquished -by(Signature) Received by Mobile Laboratory for field analysis (Signature) Datef ime <br /> Dispatched by (Signature) DatelTime Received for Laboratory by Date[Ti e <br /> Method of Shipment Laboratory Nem <br /> 1 hereby authorize the performance of the above Indicated work <br /> Special Instruction, <br />