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Advanced CHAIN OFUSTODY RECORD <br /> Date . 12S�� Page of <br /> GeoEnvironentl, Inc. , <br /> 837 Shaw Road-Stockton, California-95215- (209)467-1006- Fax(209)467-1118 \. , 2-0 <br /> Client ProjectManager 1 (�' LAC4 Tests Required <br /> f <br /> 0 Kill <br /> Samplers: (Signature) Invoice: <br /> Project Name <br /> AGE Ji <br /> L( " Client <br /> Sample Location Sample Type No.of <br /> Date Time Water Solid Notes <br /> Number Description comp. arab. r ContS. y <br /> 1 -53 <br /> e iwure ece ve y: ignature 0e/Ti e <br /> Z .,7 <br /> Relinquished by: (Signature) Received by: (Signature) Date ime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Date/Time <br /> 6 <br /> Method of Shipment: Labor ry Name <br /> C(J A/e tr K L'C4 CGAA 7� c k <br /> Special Instructions: �J _ 1 hereby authorize the performance of the above Indicated work. <br /> 2C� <br />