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�! ! ! ! ! ! i � i i i I• i i i�i i <br /> t Advanced CF1A,N OF CUSTODY RECORD <br /> --- GeoEnvironmental, Inc Date �'` Page --L ,, <br /> 837 Shaw Road - Stockton, California-95215 -(209)467-1006 - Fax (209) 467-1118 ©�_ 0 ? 3 <br /> Client L(5i4lc Le m Protect Manager i44 Tests Required <br /> done Number <br /> Samplers (Signature) Invoice <br /> Project Namet AGE <br /> �4l 4eleL-4� -�'� ` Client ❑ <br /> Sample location Solid Sample Type No of '1 <br /> Number Description Date Time Water Air Conts Notes <br /> Camp Grab <br /> ��-` bi?I� IrJ MZ 9 rel Y a£a 3 >c/- � X <br /> tuj -R 5 <br /> qrZ <br /> , <br /> Relinquished ( i ature eceive y ignature D efTime <br /> /cs �i y 766 <br /> Relinquished by (Signature) Received by (Signaturo) Date/T me <br /> Relinquished by (Signature) Received by Mobile Laboratory for held analys-a (Signaturo) AT <br /> DatefTime <br /> Dispatched by (Signature) Date/Tima Received for LaboratoryR, � <br /> / DatefTime <br /> �-lf <br /> / (f t�" to r^J <br /> Method of Shipmentf Lab atory Name qZ in L/ <br /> eL,k(�; � +�e e(4_ <br /> Special Instructions (t b <br /> Ili�� I hereby authorize the performance of the above indicated work <br />