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� ■■� �� I_ v fa_ Ititititt alw atit� tt� i t� �■ nttttarteitr �... .... es �.. <br /> Advanced CHAIN OF CUSTODY RECORD <br /> " GeoEnvironmental, Inc. 2� Date Page _3— ofd <br /> 837 Shaw Road- Stockton, California- 95215 - (209)467-1008 - Fax (209) 487-1118 <br /> Client _,. Project Manager <br /> Tests Required <br /> ez <br /> Phone Number <br /> Samplers, (Signat re) Invoice <br /> Project Name /�� ` �I AGE <br /> Client ❑ <br /> Sample Location Sample Type <br /> Number Description <br /> Date Time Water Air Solid ContsNo f Notes <br /> Comp Grab <br /> 78971 <br /> cJj <br /> 3 <br /> cAwzc 0 78972 <br /> 78973 <br /> a inqu y a urs Received <br /> y gnature) Datefr[me <br /> l/re)u <br /> ReHnq shad by Igneture) Received by (Signature) C ", DatsITims <br /> r� J <br /> Relinquished by (Signature) It l� / R �6 �i a ora ry for d analysis (Signature) Date/'rims <br /> Dispatched by (Signature) P, Y 'iu _ _ ta/Time Received for Laboratory 6 <br /> Dat lTlme <br /> Method or Shipment / Laboratory Nae:1 lbI <br /> a <br /> Special Instructions I hereby a horize the performance of the above ndicated work <br />