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j Advanced CHAIN OF CUSTODY, RECORD <br />GeoEnvironmental, Inc. <br />Date 6 Cz 4 Page of <br />4005 North Wilson Way - Stockton, California - 95205 - (209) 467-1006 - Fax (209) 467-1118 — /—^ <br />� lll�-� <br />Client Uo <br />Project Manager <br />ota- 5 a� pe � � �- - R� <br />Tests Required <br />Phone Number <br />Q�ocv� <br />Samplers: (Si nature) qo 0 Invoice: <br />Project Name AGE <br />���"`�Y �- Client []_ <br />Sample Location Sample Type No. of <br />tion r� Q, <br />Number Descri Date Time Water Solid , <br />p Com Grab. Air Conts. �[� Q QU 1 ' <br />1.2493 <br />ci35 x KK 1.2494 { <br />12495 <br />x n x 12496 <br />p-I}-lo,s" C z ka <br />x" 1249 <br />r t. <br />F•-IT-3o s� 6�z���{ IZ�S I x x x 12498 ;. <br />NC—to,5 - �f z%4 I�15 SC � <br />'� x 12499 ' <br />loyI x x <br />e inqu , ed by: () Received by: ignature ateAr 4 930 <br />/T e <br />f /5oJ <br />Relinquished b (Signature) Re ived by: (Signature) Dal /Time <br />Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br />Dispatched by: (Signature) Date/Time Received for Laboratory by: Date/Time <br />Method of Shipment: C Laboratory Name <br />�}- o v e � w� _�a°� •e -4- Ate Cit-..,, l> c l >P �. OIL <br />SpecialInstrucligTr� PRESERVATION I hereby authorize the performance o the above Indicated work. <br />++ccUVU lrllNDI I <br />,.;PmgpAr-E AacciJr �' r urnIFRC %d <br />