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1�11 NMIsill i• i• i i i i i i i tl� s, s s <br /> ( Advanced CHAIN OF CUSTODY RECORD <br /> Geoftvironmentai, Inc. �� � Date o1-017-01 page ___L__ of Z <br /> 837 Shaw Road - Stockton,California- 95215- (209)467-1006 - Fax (248)467-1118 <br /> ClientProject Manager <br /> Tests Required <br /> Phone Number <br /> a01 - qu-7- r'00( <br /> Samplers (Signature) Invoice <br /> y <br /> Project Name C�� _ AGE <br /> �t'ac' a e � 963 <br /> Sample Location Date Time Sample ype Solid No of •T - 79� -- - <br /> Number Description Water <br /> Comp Grab Air Conts 79964 <br /> ncIJ i 02-101 1V5 X 3 X 79965 <br /> x 3 7996 <br /> ;w t) /01.1 a 0 1 y ss X 3 x x 9 967 --- <br /> w5 Louoo i olalof 1L\a,' X 3 x 79968 ---- <br /> "Z o 01A-?01 X X 79969 <br /> wT /O?A-70 15)5 x k <br /> Repluo e y ignature Received y gnature DatefTime <br /> WAR q <br /> R quashed by SignatReceived b Date(Time <br /> PRE IRVATION <br /> Relinqu s s by (Signat6W8 eeNOMby Labile Laboratory for field analysis (Signature) Datelnme <br /> DEAD SPACE MSEN'T CO IAINEIR ✓ <br /> Dispatched by {Signature} DilelTime Received for Laboratory by pate ime <br /> D IN <br /> Method of Shipment CAI Over <br /> Nam <br /> Over <br /> spar'14 instructions I hereby authorize the performance of the above indicated work <br />