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1 uuj 15 <br /> Advanced <br /> CHAIN OF CUSTODY RECORD <br /> "� � <br /> GeoEnvironmental, Inc. Date Page <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006 Fax(209)467-1116 <br /> Client <br /> Phone Number t Project Manager <br /> {� # - CAFE L L ' Tests RegLilred <br /> �j r l ��ik++ •� <br /> Samplers (Signature) x� Invoice. <br /> ,� <br /> Project Name F1'R Ct V J") AGE Client ❑ <br /> Sample +�t Location Sample Type No of k� <br /> Date Time atsolid '' s Notes <br /> Number Description Wer Air Conts +� <br /> Comp Grab <br /> w A-TQr pitne 4' ! -3- <br /> J V t/1 r'J t` L <br /> I <br /> - «f rt i2r 5f. F T �- <br /> r r. r-1 n Yr• fit, ', L / i 010 <br /> s <br /> I L <br /> Relinquished y (Sognature) eceiv y gnat re Oats/Time r <br /> ,30 <br /> inggjshed b (Si 1 e) Received by (S t re) Datefrime <br /> 1 <br /> elrnquished y (Signature) Received by M ile Labor ory for field analysis (Signature) Da e/Tima <br /> Dispatched by (Signature) Date/Time Received for Laboratory by DatelTime <br /> Method of Shipment Laboratory Name <br /> DE <br /> Special Instructions f hereby authorize the performance of the above Indicated work <br />