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T <br /> J = ( Advanced CHAIN OF CUSTODY RECORD <br /> Date 0 G Page ! of <br /> U <br /> GeoEnvironmental, Inc. <br /> - 837 Shaw Road-Stockton, California-95215 -(209)467-1006- Fax(209)467-1118 <br /> Client r Project Mana or��� Tests Required <br /> Phone Number ([ <br /> Samplers (Signature) Invoice <br /> Project Name /_ _ � r_ y )4 <br /> Client�nTat (I;JG.dty C.i V ❑ <br /> _- Sample Location Sample Type No of J <br /> Date Time Water Solid 'Y �u Notes <br /> Number Description Comp Grab Air Conts <br /> _ / <br /> yL )DA dfoC r 3 It'ttc�'�Q <br /> -k46 C �a r <br /> --A-tP1OC - A4 1 A-f JI yU <br /> = K1J16 Q �i( E' Li f' / <br /> e '.s a ignature ece ve y �gneture atalTlme <br /> Re ,.'.shed by (Signature) Received by (Signature) Date1Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Tt+ne <br /> Dispatched by (Signature) Datefrime Received for Labor ory by <br /> Oatel7'.mte <br /> - u J,)s FL <br /> Method of Shipment f La bo ry amp-- <br /> Special Instructions - I hereb authorize the performance of the above indicated work <br />