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Advanced <br />GeoEnvironmental, Inc. <br />CHAIN OF CUSTODY RECORD <br />Date 2-t;- • 7- Page I of <br />837 Shaw Road - Stockton, California - 95215 - (209) 467-1006 - Fax (209) 467-1118 <br /> <br />Client .6it.,(-- <br />Project Manager <br />4 tli (1,-. i-r--- ..,ic,- : Tests Required <br />Phone Numbers, <br />-`7 <br />/ <br />Proje <br />ample <br />ct Name <br />Samplers: (Signature) /1L-,=-- <br />S <br />Invoice: , <br />k ....,, AGE P,Mi <br />Client E <br />Location Sample Type <br />No. of <br />Number Date Time Water Sid ol Notes Descrip tion Comp. Grab. Air <br />A X <br />6 i - 10 1 t o5-_:2-9. X 1 tit,L.0 <br />61- lE> <br />I <br />1 03g! 1 AX <br />, I <br />61 - arb <br />6) - 3o O ci i 0 <br />X ) <br />ItC1 1.- 0 <br />6 -35 _. b9.2g X A 1/ <br />quished by: (wgn re Received by: (Signature) <br />/i 5,T tI, <br />Date/Time <br />7 -4 - 7- ,,// 5 Oc. <br />Date/Time Relinquished by: (Signature) Received by: (Signature) <br />- <br />Date/Time Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) <br />Dispatched by: (Signature) Date/Time Received for Laboratory by: <br />,.., <br />Date/Time <br />/ <br />Method of Shipment: , Laboratory Name <br />Special Instructions: I hereby authorize the performance of the above indicated work. , <br />0