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_ <br /> [ L Advanced CHAIN F USTODY RECORD <br /> _ == e?1 <br /> GeoEnvironmental, Inc. Date 0-3 page <br /> 837 Shaw Road- Stockton California- 95215-(209) 467-1006- Fax (209)467-1118 <br /> Client (0 Projp to g r <br /> Tests Required <br /> Rhpne N, mbar / <br /> & (0n <br /> Snatur Q Invoice <br /> Project Name r AGE gr <br /> M0- \4 Client ❑ <br /> Sample Location Sample Type No of 0, <br /> Number Description Date Time Water hr Solid Conts Notes <br /> Comp drab <br /> �ZAWa -- zo <br /> -' <br /> 0 -- -0 5a <br /> 'Receivedy ignature ate(r74b <br /> e nqu s e gnat )re <br /> ,,�z <br /> Rehnqu (Signature) <br /> Received by (Signature) Da elTime <br /> Relinquished by (Signature) Received by Mobile laboratory for tread analysis (Signature) Date rime <br /> Dispatched by (Signature) Date/Time lRecelved forLLaboratory byDatelTima <br /> o� ids <br /> Method at Shipment Labor Na <br /> Lq i 4 <br /> Special Instructions 1 hereby au hors a the or o nee of the above Indicated work <br />