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• F CUSTOD�CORD <br /> ( Advanced CHAIN O <br /> GeoEnvironmental, Inc Date - -o Page ��� <br /> 837 Shaw Road- Stockton California- 95215- (209) 467-1006 - Fax (209)467-1118 <br /> Client �z� �� ,�$ Project Manager Trf CL4 Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> Project Name —TZ;� VLc1QS Y gogl � (4Q52 AGE <br /> Cllertt ❑ <br /> Sample Type <br /> Sample Location Date Time Water Solid No of *� ' Notes <br /> Number Description Comp Grab Air Conts <br /> I <br /> 1-2,o5- X <br /> tc u Q 1 Lt 35 Kvl <br /> �(1r1W LI -- I Ic t( LE <br /> ►Aw q --1 S t( i f is <br /> ' 5 <br /> Ic I w L4 e— 26 J K 5© <br /> AVVLi --Z It t S� IL4 sS - <br /> elinquis a ( _uanature eceive y ignature Date/Time <br /> Rehnqurs d by (Signature) Received by (Signature) DelelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Datelrime <br /> Dispatched by (Signature) Dale/Time Received for Laboratory by /'� Y Datef ime <br /> aims <br /> T <br /> Method of Shipment Laborato� <br /> bit <br /> I hereby authorize the performance of the above Indicated work <br /> Special Instructions <br /> I <br />