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( Advanced CHAIN OF CUSTODY RECORD <br /> N <br /> Date tt Z2-di Page A— of-- <br /> f�l GeoEnvironmental, Inc. N <br /> u 837 Shaw Road-Stockton, California- 95215 - (209}467-1006 - Fax (209) 467-1110 _ S m <br /> A <br /> Client �ttr <br /> Project Manager Tests Required W <br /> Phone Number <br /> Samplers: (Signature) ia� �� ��� i/ Invoice: p <br /> AGE [Rr" <br /> Project Name o « C i((rQ' client ❑ <br /> Sample Type '??� <br /> Sample Location Solid No. of ,ski, %', Notes <br /> Number 1 Description Date Conts. <br /> Time compy�ecrab. Air <br /> I <br /> Yitw <br /> jKVV -tn " it It <br /> fYjlVf-tS it tf (f <br /> D <br /> JNW1'ZD \t If 1+ lL m <br /> Ln <br /> -r <br /> ytAW I -V;- r u 0 Z5- foto 0 <br /> 0 <br /> 0 <br /> dv14\}1 -Zib a rr it 3©t to7S It X V- K — <br /> 'csL <br /> Rel y' <br /> Received y- igna{ure Dele/Time • <br /> /N 1h12 tet/ 1 Sao <br /> DateRime <br /> 19drinquished by: (Signet e) Received by: (Signature) <br /> r <br /> Relinquished by: (Signature) Received by Mobile Laboratory lot fleld analysis:(Signature) t 1� DabfTime <br /> Dispatched by: (Signature) Datemme PAvehred for Laboratory by: Data lime <br /> { t' Zj—D V 914 <br /> Method of Shipment: Labor cry Name 1> <br /> L ihl M <br /> M <br /> Special instructions: I hereby aut arize the performance of the above Indicated work- <br />