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�Z <br />Advanced <br />GeoEnvironmental, Inc. <br />837 Shaw Road - Stockton, California - 95215 - (209) 467-1006 - Fax (209) 467-1118 <br />CHAIN OF CUSTODY RECORD <br />Date 7 Page —/ orl- <br />0 7- �t (?5 - <br />Client 4 <br />Project Manager <br />Tests <br />Required <br />�, , r <br />Phone Number <br />416 7 103-0 �� <br />6 <br />� <br />Samplers: (Signature) <br />Invoice: <br />Project Name <br />aw <br />/L <br />' <br />AGE <br />ClientC/ <br />Sample <br />Location <br />Date Time <br />Sample Type <br />Water Solid <br />No. of <br />Notes <br />Number <br />Description <br />Comp. Grab. Air <br />Conts. <br />4+Ilk) ie /y <br />H �bDic' /Y <br />C tyle <br />EX <br />�— eAZ;rP,)AAC <br />1115 <br />Cic / C <br />exi C bum /l �/y, � r4 <br />ll 3� <br />/ <br />tq 2-- <br />e uis a (�) - <br />eceive y:-(Signature)� <br />Date/Time <br />�t7d� <br />/--�r3Cr�TS 7 <br />Relinquished by: (Signature) <br />Received by: <br />(Signature) <br />> C J p <br />Date/Time <br />'` <br />Relinquished by: (Signature) <br />Received by Mobile Laboratory for field analysis: (Signature) <br />Date/Time <br />Dispatched by: (Signature) <br />Date/Time <br />Received for Labor by: <br />Date/Time <br />0,4 <br />Method of Shipment: , <br />Laboratory <br />Name <br />� <br />C <br />Special Instructions: i� <br />I hereb <br />authorize the performance of the above indicated work. <br />c <br />30 <br />