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mm MIMI <br /> • CHAIN OF CUSTOAECORD <br /> ( Advanced Date Z r1 OS Page —/— of <br /> —42— <br /> GeoEnvironmental, Inc <br /> 837 Shaw Road- Stockton California- 95215- (209)467 1006- Fax (209) 467-1118 <br /> Client Rt)64 to t CGV Project Manager Tests Required <br /> k O-Ck <br /> Phone Number <br /> N�oo� <br /> Samplers (Signature) Irwotce <br /> AGE <br /> Project Name l T'AA-Z p. ritk u � Client EJ <br /> � <br /> Sample Typef <br /> Sample Location Date Time Water Solid No of Q Notes <br /> Number Description Comp Grab Air Conts t '4S X [ b1W <br /> i� <br /> ti 1E, a'S 0 X <br /> 81 - 20 <br /> 13 <br /> 1_ z� �t �sl �vva <br /> -;0 �i �r�QS x x <br /> f _ 3,5 al 3 � /O/D ( - - <br /> 131 -44(S1n1-t-re) <br /> If dot 10(5 X <br /> ell isre) Receivedy ignature Dale/Time <br /> t-2 �,s /1(.00c)elinquished Received by (Signature) Date(Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for held analysis (Signature) L Date/Time <br /> i <br /> Dispatched by (Signature) Date rime Received for Laborator y Date/Time <br /> Method of Shipment boratory J+(ame <br /> P i <br /> ! hereby authonxe She performan=ofthe bove indicated work <br /> Special Instructions �� <br />