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�� :� ear iii i t1� i i � � � t� � t� � � l♦ <br /> Advanced CHATF CUSTODY RECORD <br /> -- GeoEnvzronmental, Inc ;—�`P �— Date �� � Page of <br /> 837 Shaw Road-Stockton, California-95215- (209)467-1006 - Fax (209)467-1118 <br /> Client ( � �? , Project Manager Tests Required <br /> u'i L <br /> Phone Number <br /> Samplers (Signature) ��; Invoice <br /> Project Name " `,��� - 40 ` AGE <br /> Chert <br /> � <br /> Sample Location Date Time Sample Type solid No of <br /> Number Description Water <br /> Comp Grab Air Conts Nates <br /> 3:5 <br /> ✓ X A C� 88230 <br /> 88233 <br /> ellnqu� a y ( ignatbi1 e we y (Signature) <br /> (c'_ , 0 ,` <br /> Relinquished by (SignaluM Received by (Signature) Date(Tlme <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Received}or Laboratory by Date/Time <br /> Method of Ship t 0 QALaboratory Name <br /> t � Voll, l'C in�wi�I L Mir gt t <br /> Special Instructions <br /> gfiEC�tn+VA-(rl`�.�1 s hereby authorize th performance of the above indicated work <br /> MID C� <br /> HEW <br /> rl art 1 P"r-� �Ul'l il�liYtflJ� ' <br /> - - y p <br /> C" n t in I/,f 4 I n e ! 1 n-, I ✓L1 r <br />