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( Advanced CHAT OF CUSTODY ECORD <br /> GeoEnvironmental, Inc. Date 5 tTt.. Page --Lot <br /> 837 Shaw Road-Stockton, California-95215-(209)467-1006- Fax (209)467-1118 <br /> Client Project Mana r <br /> Tests Required <br /> P,henq Number <br /> 6? `a <br /> Sa ers (Signature) ¢ Invoke <br /> Project Name �-- ® AGEc� <br /> Sample Sam le T � <br /> Client � <br /> p Location Date p ype No of <br /> Number Description Time Water Air Solid Coats Notes <br /> Comp Greb <br /> �- 3 I 74 <br /> ` d <br /> y ( r nature) ve y rg tura /"1 D te/TEme <br /> Reirnqurshed by {Sig ure) R cel y (Srgrtature) r 17/2 <br /> �l <br /> DatelTmte <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) <br /> DatelTime <br /> Dispatched by (Signature) Oate/Trme Received for Laboratory by <br /> Date/Time <br /> Method of Shipment La ratory Nam <br /> Special Instructions <br /> 1 hereby authorize the pe formance of the above indicated work <br />