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s ire r I� I� � 11� liiillll� lillll� _ <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvi:ronmental, Inc. Date �]'-ZY-v� Page --Lot <br /> - <br /> 837 Shaw Road - Stockton, California- 95215 - (209) 467-1006 - Fax 1209}467-1118 <br /> Client We �v r` ([ Project anager <br /> Uv r�� pc1U a �,��o Tests Required <br /> Phone Number <br /> Q J- 9&7- 1I0(o �► <br /> Sampier . (Signature) '�4 Invoice: <br /> Project Name _ AGE <br /> We rx Client ❑ <br /> Sa ype � <br /> Sample Location Date Time Solid No. of '� Notes <br /> Number Description Wat r Air Conts. C7 <br /> Comp. Grab. <br /> J <br /> lovi <br /> %g3kg� lot �Z x <br /> t35D <br /> `�/ y-44oZ. <br /> uJoqJ40L fAVV—U <br /> Oateffime <br /> Rquill.hed <br /> y: �gna:u ) eceive y: ignature �`i<`�/ f/00 <br /> by: { ignature} Re ved by: {Signature}-- Date/Time <br /> — {►O ON 31�'L'us OTHER <br /> Relinq ' nature) pPPROFRiATE calve y o e Laboratory for field analysis:(Signature) Date/Time <br /> GOOF]C()NDITiON <br /> -,' ,CE ABSENT CONTAINERS <br /> D1 apatckB$t�yR Date/TimeReceived for Laboratory by: f° , pate ime <br /> Method of shipment: C1 Laboratory Na� verny c Cit & l/ <br /> Special Instructions: I hereby aut rize the performance of the above indicated work. <br />