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WIM MIM Ml• <br /> Advanced CHAT OF CUSTOD RECORD <br /> - <br /> - GeoEnvironmental, Inc. Date <br /> � Z- c <br /> 837 Shaw Road- Stockton, California-95215 - (209)467-1006- Fax(209)467-1118 <br /> Pr lett Manager <br /> Clientmp kcG�"4�A Tests Required <br /> hone Nmber <br /> Sa leis {Signature) Invoice <br /> AGE 0( <br /> Protect Name �.Za L t,q- � Client ❑ <br /> Sample Type <br /> Sample Location Date Time Water Solid No of IU Notes <br /> Number Description comp Grab Air Conts <br /> LQ <br /> Y- <br /> 13719 k <br /> %ulsere} aceive y ignature ure} Received by (Signature) Date ims <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Oats/Time <br /> Dispatched by (Signature) DatelTime Receiv La b0 <br /> Date/Timen <br /> Method of Shipment Laboratory Name <br /> Special Instructions L I hereby aut ize the performance of I Bove indicated work <br />