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0 <br />D <br />r <br />m <br />N <br />Advanced <br />GeoEnvironmental, Inc. <br />837 Shaw Road - Stockton, Calitomla - 95215 - (209) 467.1006 - Fax (209) 467-1118 <br />CHAIN OF CUSTODY RECORD <br />Date 0 2 Page 1 of <br />yam rs: I I nr U1l.G. <br />Project Name AGE F!fr <br />iQ e oa �!?Vf11/Client <br />Sam p!e Type <br />Sample Location Date Time Water Solid No, °l Notes <br />Number Description Air CorttS, <br />Comp_ Grab. <br />67 -Q <br />-3-o2 <br />k' <br />X <br />- 3- 2 <br />�� <br />x <br />e in ui tied n ur <br />Fleceived by: rgnature <br />alert e <br />Relinquished by: Signalwe) <br />Received by: (Signature) <br />fDate ime <br />Relinquished by: (Signature) <br />Receltied by Mobile Laboratory for Heid aaalysia; (Signature) <br />Dale/Titoe <br />Dispatched by: (Signature) <br />DaterTime <br />Received for Laboratory <br />'Z <br />Date/Time <br />-t`l k 09: J <br />Method of Shipment: <br />L• retort' e <br />Speciallnstrucuons: <br />1 hereby authorize tha rform nce of Ilia above indicated work. <br />C <br />I <br />I <br />ry <br />Iv <br />I <br />Rl <br />9 <br />CD <br />M <br />D <br />r <br />I <br />M <br />C) <br />IT <br />RJ <br />rU <br />fU <br />R) <br />00 <br />lD <br />Vt. <br />