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� � � � r � � � � � � � �■ � ■■■� ffffffffff� <br /> � Advanced <br /> CHAIN OF CUSTODY RECORD <br /> - GeoEnvironmental, Inc. 3 C Date Page / of z'- <br /> 4005 North Wilson Way-Stockton,Calltomia 95205 (209)467-1008-Fax(209)487-1118 <br /> ,tient l -S Project Manager Tests Required <br /> /i'*t It <br /> Phone Number fo <br /> naX <br /> Samplers (Signature) Invoice <br /> ro)ect Name L'�,_ l 1 � ��,` � , AGE <br /> � G � C� U�.o .� �/✓ client p <br /> Sample Location Dale Time Water Sample Type Solid No of ! 69766 1 <br /> Number Descrlptfan comp Grab Air Conts , <br /> 07w �y1 5 X 69767 <br /> 69766 <br /> C f y �97ss <br /> r <br /> 69770 <br /> 01 , 6 9 7� 1 i <br /> �w 3v/ <br /> e inq y ( i net <br /> ure Received by gnature DatelTime <br /> lelinquisha y ( gnature) Rece[ved by (Signature) Dale/Time <br /> lelinqu shed by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Aspatched by (Signature) Date/Time Received for Laboratory by tale e <br /> Aelhod of Shipmenta oralo m <br /> AC. OU iG VCr, _�,s� OTHER rt,r <br /> Special Instructions — --PRESERVATION I hereby authorize the performance of the above indicated work <br /> CLCD C .L ITJON v/' APPROPRIATE <br /> M- <br /> - t <br /> <',I -f A <br />