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Advanced CHAT F CUSTODY RECORD <br /> GeoEnvironmental, Inc. ���,1�� �� <br /> Date Page —L of <br /> - - - -- __. <br /> 837 Shaw Road-Stocktort, California- 95215 - (209) 467-1006- Fax(209)467-1118 <br /> Client Proje Manager Tests Required <br /> an umber <br /> C <br /> M s (Signature) Invoice <br /> Project Name AGkT�— <br /> �—�a Client ❑ <br /> Sample Location Sample Type Na of <br /> Number Description Date Time Water Air Solid Conts Notes <br /> Comp Grab <br /> 1 zze, <br /> GOOD CON MICR <br /> t1EAD PA AB ENI <br /> yp fd(1 Ate Q <br /> PRE IM <br /> 7-Re in ui e gn re Received by gnatUre ate <br /> Relinquished by (Signature) Received by (Signature) Datefflme <br /> Relinquished by (Signature) Received by Mobile Laboratory for fietd analysis (Signature) Date rime <br /> Dispatched by (Signature) Date/Time Rec ep rtabafatory bD elTime <br /> Method of Shipment Laborviory Na <br /> 4 <br /> Special Instructions REOD SEA ED&}NT .�?�!� C f � i hereby ut izs the lorman e f the above Indicated work <br />