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Advanced i <br /> 775' JZ L tk CHAIN OF CUSTODY RECORD- <br /> GeoEnvironmental, Inc. �o'F Date <br /> !! -q lo Page l of <br /> -" of Northern Calrfonna <br /> f803 West March Lane, Suite A-Stockton, California-95207-(209)956.0264 Fax(209)956-0700 <br /> Client CIO t Project Manager <br /> Tests Required <br /> C,r�1c <br /> Phone Number <br /> 'Zvct �b <br /> Samplers (Signature) �� Invoice <br /> Project Name ACE <br /> <C C -- C4 Client ❑ <br /> Sample Location Sample Type No -Z- <br /> Number <br /> Number Description <br /> Date Time Water Air Solid Contsj Notes <br /> Camp Grab <br /> Mei -H I�Vc L -Zc � ' <br /> Rel i +e y (Si nature) Te—cc ive 3111U'kA ( ignature DatelTime <br /> HelinqL13hed by (Signature) Received by (Signature) �' 1 A N� ^ZS 5 ,00 <br /> Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) <br /> DatelTime <br /> Dispatched by (Signature) Date/Time Be sive forLabor r y Date/Time <br /> Method of Shipment Labors ory Name <br /> T fig.-- a L ceL ZA <br /> Special Instructions t hereby authorize the performance of the above indicated wor <br />