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LII =T <br />Advanced <br />GEOEIlVl1'OIlITlClltal, Inc. <br />4005 North Wilson Way - Stockton, California - 95205 - (209) 467-1006 - Fax (209) 467-1118 <br />CHAIN OF CUSTODY RECORD <br />Date `f rl yY' Page —L— off— <br />Client <br />¢ S Project Manager <br />A� h Tests Required <br />Phone Number <br />/ <br />a�%u✓� <br />Samplers: (Signature) ��� Invoice: <br />AGE <br />Project Name <br />Client (� <br />Sample Type <br />Sample Location No. of <br />Date Time Water Solid Notes <br />Number Description <br />p camp. Grab. Air Conts. <br />Ca►�, ;1�3� <br />L 20 <br />dhi 1, 'Je 3 <br />Reiijqqu!ishedy: ( ign re) ice' <br />ec ive y: (Signal <br />Dale/T' e <br />Dale/Time <br />Relinquished by: (Signature) <br />Received by: (Signature) <br />Relinquished by: (Signature) <br />Received by Mobile Laboratory for field analysis: (Signature) <br />DalerTime <br />Dispatched by: (Signature) <br />Date/Time <br />Received for Laboratory by: <br />Dale/Time <br />Method of Shipment: <br />Laboratory Name <br />I A <br />, /P if <br />Special Instructions: <br />I hereby authorize the werformance of the above indicated work. <br />