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MM <br /> Advanced CH i <br /> � AIN OF CUSTODY RECORD <br /> GeoEnvironmental Inc. <br /> t� s Date-L?-/Z 6 Page <br /> of Norrlterrt Culrfornra <br /> 1803 West March Lane Suite A Stockton California-95207 (209)956.0264.Fax(209)956-0700 <br /> Client M Project Manager <br /> R" Tests Required <br /> Phone Number <br /> 7-,,q q LJU 2 (]V <br /> Samplers (Signature) Invoice <br /> Project Name 7 AGE (3 <br /> Client ❑ <br /> Sample Location Sample Type - <br /> Number Description Date Time Water Air Solid C s �� �� Notes <br /> Comp Grab <br /> l 1 I{3R qy� <br /> I J 7 S' S wC 5Lt- �C� 75 <br /> 7 5' �� ��i `>5+ (17 5 � <br /> D",;4( ti F-SZRk,-ff2 S� , X ✓ 1� <br /> eJinq ed by (S�gnature) ecerved y ( �gnalure <br /> �� 5?.9 N Date/Time <br /> Relinquis e b (Signature) =Q <br /> Received by (Signature) <br /> D telrrme <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) <br /> Date/Time <br /> Dispatched by (Signature) <br /> DatelTime Roc a or Lab t r by Date/Time <br /> Method of Ship ent �` — F i""#o <br /> I <br /> Laboratory Name <br /> Special Instructions <br /> I hereby authorize the performance of the above indicated work <br />