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157-79 <br /> Advanced CHAIN OF CUSTODY RECORD m <br /> _ ©ate - 7- 4 0 Page t <br /> GeoEnvi>Ironmental, Inc. <br /> 4005 North Wilson Way•Stockton,Caltfomia-95205-(209)467.1006-Fax(209)467.1118 m <br /> m <br /> Client $f4 DF_ p41 E44 . Pro A+t C er Tests Required W <br /> w <br /> Phone Number <br /> zA C b { <br /> � N <br /> Samplers.(Signature) invoioe: <br /> LDA <br /> Project Name client ❑ <br /> 1 W <br /> Sample <br /> Location Date <br /> Type No, 90 <br /> Number Descri ion Qate Tune Water Solid Notes <br /> Camp. Grab. fill contS. <br /> S� 1 w f\ fnCx�tt j. .a� 3'.1 r7 SltPt*e <br /> � 1-1 at��jtD e} � t Sec e I F� a f <br /> Tocl��1� No. 1 � Svrn�o - � rgSS <br /> D <br /> M <br /> co <br /> 0 <br /> a <br /> z <br /> I L <br /> rnqurs na ure Receive4l UP ignature ofiteliime '� ) <br /> CC <br /> elin4t shed by: Signeture) Received by:48ignature) DateiTime <br /> I �r" <br /> linquished by: (Signetuue) nature) vatefrime <br /> Oispatc%ed by:(Signature) Receivad for labo lory Oatefrime <br /> i1�!?04 dga24 <br /> i Nothod of Shipmem: l.aberatory Name D <br /> ore 'c f •f- A-*/ ' en M <br /> speotal 3nsttuotions: - t horeby authorize the performance of the above Indieated work. <br /> C 0 GLn <br /> via, Ca It �Ji - .—vx�.�� pJ IaOd e8au� r <br /> 1 <br />