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AdvanceidlCieo- <br />Environmental <br />An Employee- Otvnerl Company <br />Project Name <br />Client <br />Invoice to: AGE ❑ Client <br />Sample ID/Location/Description <br />Pby -1 <br />Date <br />CHAIN OF CUSTODY RECORD <br />DATE: j(J ! t% f PAGE -LOF <br />Project Manageq� i <br />1, rr k' M (1 V <br />Sampler (initials & signature)) <br />.1//QV, <br />Lab Project No.: <br />Time Matrix I Number Notes <br />Phone: (800) 511-9300 <br />Fax: (888) 445-8786 <br />Analysis Required <br />Relinquished by: i <br />Dale: <br />Time: <br />Laboratory: <br />Courier: 7 <br />Received b : <br />Date: <br />Time: <br />I (✓� <br />�l. <br />I` f y <br />I <br />Relinquished by: <br />Drage: <br />Time: <br />iv d by <br />Date: <br />Time: <br />p <br />V/b <br />�ec <br />Relinquished by: <br />Date: <br />Time: <br />Ved by: <br />Date: <br />Time: <br />Requested Turn Around Time (circle): 24 hours 48 hours 72 ho 5 days (standard) <br />r: <br />Matrix Codes: A = Air W = Water <br />S = Solid <br />Special Instructions to lab: <br />I hereby authorize the performance of the above indicated work. <br />i <br />/ <br />I <br />Geolracker EDF to: ❑ geotracker@advgeoenv.com ❑ <br />Global ID: <br />Pn-- ° �t <br />