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Advanced <br />-� GeoEnvironmental, Inc. <br />4005 North Wilson Way - Stockton, California - 95205 - (209) 467-1006 - Fax (209) 467-1118 <br />CHAIN OF CUSTODY RECORD <br />Date 2 ' Q - q Page �t-- of Z <br />ClientProject <br />1400 <br />Project Name Kt S <br />Sample <br />Number <br />1 wla <br />&45 °� (� r0 G � r y <br />Location Date <br />Description <br />Time <br />Manager <br />14eyrj ll M ( Ki If 0.0h Tests Required <br />Phone Number !G <br />Q -0q ) H6?' 1006 <br />Samplers: (Signature) Invoice: <br />�� AGE IN <br />2441:1\&tXU_t"� / d/ Client ❑ <br />Sample Type � <br />Water Solid No. of .�� / Notes <br />Comp. Grab. Air Conts. <br />3-3 C <br />5*,11 Lf), ¢QsT,►,� �j1r <br />� 13'Q <br />17;fy <br />is <br />j <br />✓ <br />�� <br />e rnqurs a y: (Sr nature)rgnalure <br />.hA <br />a <br />-- <br />1,4/,t -4 K I <br />- A r- <br />Date/Time <br />2 - 16_7 f�j 5-,3 � <br />Relinquished by: (Signature) <br />Received by: (Signature) (� / ,y <br />Date/Time <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 Laboratory by: <br />Date/Time <br />Method of Shipment: <br />Laboratory Name <br />n ► �- A H 4 Ixii cc I <br />Special Instructions: I I hereby authorize the performance of the above indicated work. <br />