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t i i i i i i f t i i t t i i i i i t <br /> j _ Advanced CHAIN OF CUSTODY RECORD <br /> -- GeoEnvironmental Inc. Date 1't C� Page or <br /> k- <br /> Client <br /> 837 Shaw Road -Stockton, California-95215-(209)467-1006- Fax (209)467-1118 <br /> . 1�6t 4e5 Ci��� yt Project Manager <br /> Tests Required <br /> Phone Number <br /> C-2�0 ) te <br /> Samplers: (Signature) Invoice: <br /> ProjectName --:If <br /> t ✓vttc� ��'f��� �t�'�Crt.( �Jrrc��..� � �U <br /> Client <br /> zJ� <br /> - Sample Location Sample Type No. of � /� ,� <br /> Number Description Date Time Water Solid [� Notes <br /> p Comp. Grab. Air ContS. <br /> t4w�- io Mw- f q- 6A, / 1 <br /> '30 <br /> (.Ta� <br /> MW '6cbn <br /> � <br /> Relinquished y: (Signature) 11 eceive T ,gnature Date/Ti e <br /> ��. `► `�' $..fit''.-ocl �`J�l� <br /> Reli wished by: (Si gnature) Received by: (Signature) Date?Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Sign ure) Date/Time <br /> Dispatched by: (Signature) Date/Time Received for r ora ory by Da /Time <br /> i <br /> ILI 3 <br /> Method of Shipment: Laboratory Name <br /> / CAL Te C- <br /> Special Instructions: I herebyauthorize the <br /> performance of the above indicated work. <br /> dJ�-epi �ip� <br />