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ebm IM M M M M m4r M M M =1 1% = up , <br /> !v <br /> CHAIN OF CUSTODY RECORD--" <br /> Advanced <br /> .�: Date y 5 d' Page <br /> GeoEnvironmenta[, Inc. <br /> ;. <br /> 4005 North Wilson Way-Stockton,California-85205 (209)467-1006-Fax(209)467-1118 4 3 ' <br /> Client �6u Project Manager / Tests Required <br /> Phone Number <br /> Samplers: (Signature) I Invoice: <br /> AGEr < ` <br /> Project Name {{ �� /���� Client ❑ <br /> Sample Type <br /> Sample location Date Time Water Solid No. of y r V r � .. ` ; ; �/ ��:•Y <br /> Number Description Comp. Grab. Air CDnts. <br /> L J /x <br /> I L <br /> DalelT me <br /> DelefTlme <br /> e ir�gw e �� t +g�n `ure) ace y: rgnature � j } <br /> 3-31-�rFs <br /> Relinquished by:(Signature) Rec ' ed by: (Signature <br /> Relinquished by: (Signature) Received by Mobile laboratory for field analysis:(Signature) Dele£TEme <br /> Date/Time Received for Laboratory by: DatelTime <br /> Dispatched by: (Signature) <br /> Laboratory Name <br /> Method of Shipment: 0 V-e <br /> Special instructions: UDAS -O&G1"MBALS1 OTHER 1 hereby authorize the performance of the above Indicated work. <br /> PITURI/1"TIM <br /> 1 <br /> GO,:f;GONDITION APPROPRIATE <br /> Ci <br /> i <br />