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• s <br /> ( Advanced CHAIN OF CUSTODY RECORD <br /> -_ <br /> GeoEnviron mental, Inc. Date ��Z Page of <br /> 837 Shaw Road -Stockton, California- 95215 - (209) 467-1006- Fax (209)467-1118 <br /> Client � Project Manager Tests Requir <br /> ol <br /> Phone Number <br /> Sampl : (Signature) Invoice: <br /> t. AGE [�4-- <br /> Project Name Client ❑ <br /> Sample Type <br /> Sample Location Date I TimeSolid No. of Notes <br /> Number Description Water I Air Conts. <br /> Cory Grab. <br /> Relinquish y: gnat e � Received y: ignature <br /> DaterTi e <br /> ek2.oW oL <br /> Relinquished by: (signatu Received by: (Signature) Date !me <br /> Resin uished b (Signature)q y: ( g ) Received by Mobile Laboratory for field analysis: (Signature) DatelTima <br /> Dispatched by: (Signature) Date/Time Received for La ratory by- Date/Time <br /> ,A I 2- 7-G2 <br /> b <br /> Method of Shipment: � Laboro Name <br /> Special instructions: i hereby authorize lhe performance of the aboye'indicatod work. <br />