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GHA(N OF CUSTODY RECORD <br /> Advanced Date Z401"- Page of� <br /> --- <br /> �, ,.;.•.. G oEnvironmental, Inc <br /> 4005 North Wilson Way-Stockton,'Ca:iiorna-85205-{ZOS}487-10013 Fax467-1118W- <br /> Project M-arnaager Tests Req <br /> Client <br /> P ne-N be <br /> Z0177—I4d <br /> Samplers: (Signature) Invoice. <br /> N �r AGE <br /> ClienC❑ <br /> Project Name <br /> .� Sample Type <br /> Sample Location Salid No.of Notes <br /> p Date Time Water <br /> � idumber Description cornp. Grab. Air Cortts. 01. <br /> `� 7p 3 r �AS'r �• Irk 33 p jA3 6n�� <br /> M. —S, P. g, P <br /> t� <br /> <= (�I r N 9 j •� 5 �e 1 f �t�� ` � � � � V� <br /> ��- <br /> ate(Cim <br /> ecerve y: ignature DXI7 S� r4� p <br /> Q nqula s ( siure) � ! .v0 <br /> i' atelfi to <br /> Belli wahad 6y:(Si9natu[e) a ed b (Signature) <br /> :.... <br /> 2 of v <br /> CO = Y. <br /> 17[tat JTlrne <br /> Relinquished by (Sipnewre) ecetved by Alobile l aboiatary for field anal ais:{Signature) <br /> Q <br /> Received for labotalOry by: �alelTime <br /> gateMme <br /> z Dispatched by:(Signature) <br /> E Laboratory Name r <br /> p�j Method of Shipment: ckL, f 1MnLlly-56► l Itc, thereby :zuthorize a Performance of the shove Indicated work <br /> Q <br /> QSpecial lndhuetions: <br />