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� �� � '• � a• � ti ti tri w ittititit� t� �.. ltilt� <br /> t Advanced CHAIN OF CUSTOD RECORD <br /> �- GeoEnvironmental, Inc. Date 3 'rd 'Y� Page 3 of-- <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467 1006-Fax(209)467 1118 <br /> Client Project Manager <br /> K P W&I [t "K Win Tests Required <br /> Phone Number <br /> UL01) 40 - 100G <br /> Samplers (Signature) Invoice <br /> Project Name VJ.w ( k{d Pro?-tA/ WAW-Uu AGE QJ <br /> Client a <br /> Sample Type <br /> Sample Location Date Time Water Solid No of <br /> Number Description Air Conts <br /> Comp Grab <br /> t <br /> -ko 1-+3-q91 q%-t w o l d <br /> gr36 X a L <br /> U S -60 1 d . <br /> B 6 - ;-S 16fKr� - a i d r <br /> V6 - 30 r 6:�9 l <br /> ®6 40 k 77=a7 <br /> F ( -� 0 t-1414 vf): ,Vl` <br /> Relinquishedy ( 1 t Received by -('Signature) d <br /> Relinquished by (Signature) Received by (Signature) DateTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatelTime <br /> Dispatched by (Signature) Date/Time Receiyeq for Laboratory by t Dataftime <br /> r0. V ,91 9 <br /> Method of Shipment Laboratory Name <br /> N 1L (AM, bit L <br /> Special Instructions [cultPRESERVATION 1 hereby authorize the performance of the above indicated work <br /> L/ 0A9DPPnm <br /> HEAD SPACE AB � <br /> SENT CONTAINER <br /> I <br />