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• s s _ <br /> Advanced CHAIN OF CUSTODY RECORD <br /> _ == GeoEnvironmental, Inc y�a�00 Date d Page Ur— <br /> 837 Shaw Road - Stockton California 95215- (209) 467 1006 Fax (209)467-1118 <br /> Client r Lts' � Project Manager Tests Required <br /> Phone Number <br /> C( ) i4�7--mn( <br /> Samplers (Signature) Invoice <br /> AGE,,-- <br /> Project Name j/`l C f 1 Client ❑ <br /> Sample Type <br /> Sample Location No of / Notes <br /> Date Time Water Solid <br /> Number Description Comp Grab Air Cents <br /> Q Rq g 1:5 X /X <br /> 2Zdr z yet d <br /> XX <br /> e inquis y gnature) eceive y (Signature; Dale/Tim <br /> Relinquished by (signature) Received by (Signature) Datetme <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatelTime <br /> Dispatched by (signature) Date/Time Rec ad or Laboratory by Oate tme <br /> Method of Shipment 111110000, <br /> Laborat eme <br /> im? G i C G <br /> Special Instructions � r GOODCONDITf PR1A I hereby authorize the performince of the above Indicated work <br /> iIE AD SPACE ABSENT CONTAINERS <br /> DECHLORINATED IN LAB PRESLR4 ED IN LAB <br /> VOA OR(} METALSOF]-rFR <br /> RECD SEALED &INTACT VIA PRF FRVATToN I I <br />