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Advanced OF CUSTODY CORD <br /> ; <br /> GeoEnvironmental Inc Date 6-jq Page Z of3- <br /> 4005 North Wilson Way Stockton California 95205 (209)467 1006 Fax(209)467 1118 <br /> Client Project Manager <br /> 14 et, 0 h c K' 4 k{n Tests Required <br /> Phone Number <br /> -.oq - 46 7 - 100 � <br /> Samplers (Signature) ��� o� Invoice , <br /> Project Name Lkaft C.AtVia a' — r(adjsQy, ,'t�tsµ+ '�/I.C , J a*` +r CIeE [K <br /> Sample Location EJ <br /> Sample Type No of °����°O / �' r '� s� <br /> Date Time <br /> Water Solid b/ <br /> Number Description comp Grab Air Conts <br /> MWP - 3�- 1011 <br /> h ) <br /> t C1•q 5 <br /> ys <br /> 10;50 I s` <br /> Mw 19- 30 6� rq-7g 11� 1 � x p 1CA <br /> h <br /> K WI <br /> Mw rq —�o ? W. �y 1� it d cl <br /> Relinquished y ( rgnature) eceive y (signature) { Ds}Y. Dater;rme <br /> c -��•P6 15��S' <br /> Relinquished by (Signature) Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for held analysis (Signature) Date/time <br /> Dispatched by (Signature) Date/Time received for Laboratory by Date/Time <br /> Method of Shipment Laboratory Name <br /> -- V (4y� <br /> Special Instructions V PRESEWATION I hereby authorize the performance of the above indicated work <br /> GOOD CONDITIONHEA <br /> D SPACE ABSENT CONTAINERS_.__ _ <br /> F <br />