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j Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date (o-tz-o'E Page 3 of <br /> 837 Shaw Road- Stockton, California- 95215- (209)467-1006 - Fax (209)467-1118 i u �� 7,0 <br /> Client GPo r� Project Manage <br /> LbaNa �8o Tests Required <br /> Phone Number <br /> ZOq - `E(,q-1Do� <br /> J Samplers: (Signature) �� Invoice: <br /> Project Name � ow' s�� -- m� Q��il( AGE <br /> Cliem <br /> Sample Location SamDate Time Waterple Type Solid No. of ��4� Notes <br /> Number Description temp. Grab. Air Conts. 1 <br /> 16? 45 \/ 1ne� <br /> q D lo-tZ 4(= I � <br /> gl- SO L� n � �j jZ3o <br /> g2- a u 2 S 1`f`l 5 <br /> gz- +o Itite] t o (KSS <br /> 02— 1S ,l tt Ci tS jJ� � <br /> ��2-so fa tt <br /> Relinquished y: 1gnatu a scene T ignatura <br /> Date/Time <br /> tO—(2—OSE C>'60� <br /> Refinquished by: (Sig ure) Received by: (Signature) �� Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory Date(Tims <br /> V / <br /> Method of Shipment: /' I , oratory Name <br /> Ar <br /> Special Instructions: I hereby authorize the performance of the above indicated work. <br />