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� � � � ! � � � � � � � ffffffflf. �� �� ffffffflf. �■ <br /> Advanced CHAIN OF CUSTODY RECORD <br /> - Date �� » ; � ' _ page of � <br /> -- GeoEnvironmental, Inc. <br /> 4005 North Wilson Way-Stockton,California 95205-(209)467-1006-Fax(209)467-1118 <br /> Project Manager <br /> Client ., . Tests Required <br /> � a <br /> f '9 <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> Project Name AG E EJ <br /> Client ❑ <br /> A + s <br /> Sample Location Sample Type Na of <br /> Number Description Comp <br /> Time Water Air Solid Conts 2 Notes <br /> Comp Grab <br /> r <br /> s_ <br /> I <br /> Relinquished y (signature) Received y ignature Date/Time <br /> Relinquished by (Signature) Received by (Signature) DatelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) DatelTime Received for Laboratory by Date/Time <br /> Method of Shipment Laboratory Name <br /> I <br /> Special instructions I hereby authorize the performance of the above indicated work 1 <br /> z �, f <br />