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Advanced <br />GeoEnyiron mental, Inc. <br />4005 North Wilson Way - Stockton, California - 95205 - (209) 467-1006 - Fax (209) 467-1118 <br />CHAIN OF CUSTODY RECORD <br />J` r <br />Date d"If Page of <br />IS LI %'k zACs�� <br />Client �� s� S` ���� Project Manager <br />Phone Number <br />Samplers: (Signature) <br />Project NameAGE <br />fPt6e J Ay OAe•r-(at4 <br />Sample Location Sample Type No. of <br />Number Description Date Time Water Solid <br />p comp. crab. Air Conts. <br />ol <br />Tests Required <br />Invoice: <br />[ <br />Clier -7 <br />/ Notes <br />f <br />F -t- is 5' <br />6/r Z Y <br />l <br />x <br />1 <br />Hit <br />a ups ( ignature) <br />y: ( ign a <br />' ICG�L <br />AZ &--;A161Date <br />ime <br />Relinqui ed by: (Signature) <br />R ived by: (Signa e) <br />Date/Time <br />Relinquished by: (Signature) <br />Received by Mobile Laboratory for field analysis: (Signature) <br />Dale/Time <br />Dispatched by: (Signature) <br />Date/Time <br />Received for Laboratory by: <br />Dateirime <br />Method of Shipment: <br />�aL <br />Laboratory Name <br />c <br />Special Instructions: VM I U&UJ MEIALS1 OTHER I hereby authorize the perfo'fmance of the above indicated work. <br />CEO __SIL_ PRESERVATION I r-\ J <br />