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[ ( C t ( [ ( t t [ C ( f [ [ t ( t t <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date �"'1�D Page of <br /> 837 Shaw Road-Stockton, California-95215- (209)467-1006-Fax (209)467-1118 <br /> Client t6 �°��� Project Manager <br /> Tests Required <br /> Phone Number <br /> Samplers: (Signature) <br /> � Invoice: <br /> Project Name l.G�t - I"1� ©Cf'1`C _ �✓ �$ AGE <br /> Client <br /> Sample Location Sample Type <br /> Ik <br /> Date Time Water Solid No. of j , <br /> Number Description Comp. crab. Air Conts. Notes <br /> I'1 -ID <br /> Fl- ly rt tt Cf litqqD <br /> Ft-x 155 <br /> btd <br /> N-30 it `f ;3 o <br /> IV <br /> e mquis a y: (Signature) ecerve y: tgnature <br /> � Datp/Time <br /> 'v <br /> Relinquis d by: (Signature) Received by: (Signature) — {, Y/_D <br /> v c-- Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) i Date/Time <br /> Dispatched by: (Signature) Dete/TimeReceiv or, abor oVby. <br /> Date/Time <br /> Method of Shipment: ° Laboratory Name <br /> Special Instructions: I hereby authorize the performance of the above indicated work. <br />