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Ozl� _ Advanced <br /> CHAIN PF)CUSTODY RECORD <br /> -_ GeoEnvironmental Inc. Date ' Page —�_ °r_,�- <br /> 837 Shaw Road - Stockton, California 95215- (209) 467-1006 Fax (249) 467-1118 <br /> Client Project Manager Tests Required <br /> PV0ne Nipber <br /> Sam rs (S ature) invoice <br /> Project Name2i ( AGE ❑ <br /> t�Lt4 �ti (� Client ❑ <br /> Sample Type <br /> — Sample Location Dale Time -_.--... No of <br /> - umber Description Water Air Solid Conts Notes <br /> Camp Grab <br /> q12-403 (-2- <br /> F �3l � <br /> ICF�I� <br /> IfI?AI]SP CE A986NT C ONT-AIN s_.. <br /> - <br /> DECHLOF INATED IN LA RESERVIRB IN ISA <br /> -- <br /> rRESERN NnON <br /> Relinquis ad by ignatureJ Received by ('Signature) Ua elrime <br /> Relinquished by (Signature) Received by (Signature) 1 Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatelTime <br /> Dispatched by (Signature) Date/Time Laboratory by Da (Time <br /> — Method of Shipment Laborat a <br /> Species Instructions Ui) � j � I hereby authoriz a pe orm rice of the above Indicated work <br /> RECT SEALED&INTACT Vl Ll (� ! <br />