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( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc Date `tel Page —L ofJ�� <br /> 837 Shaw Road- Stockton, California- 95215- (209)467-1006- Fax (209) 467-1118 <br /> Clientt - Project Manag r <br /> P Tests Required <br /> Pone Number <br /> DC7 1 C'C6 <br /> Samplers (Signature) Invoice <br /> Project Name AGE <br /> C V-C—L t)ta Client ❑ <br /> V � � <br /> Sample Location Sample Type No of �- <br /> Number Description <br /> Date Time Water Air Solid C nos Notes <br /> IComp Grab <br /> CA-S 3 X 10 <br /> -V�- 7---5 4- 1 C-Fk 5 XIX <br /> X Ix <br /> 65 � <br /> e inq is e y ignat ► , eceive y Sri at`e/T e <br /> clic ' 7 <br /> Relinquished by (Signature) Recelved y (Signature) DRISITIme <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) �� Date/7ime <br /> 11-1 1 <br /> Dispatched by {Signature) iC&lAate i eReceived for laboratory by ` Date/Time <br /> (aCOD CONDITION APPROPRUTR <br /> Method of Shipment j DECHLORINATED IN LAS PRESERVEt7INJ.AB Laboratory Name <br /> C)UeL-,%k`- I ` VOA9 O&(1 I WrAES I 4TfIER C'�V" � <br /> Special instructions it ff I hereby authorize the PerformAce of the above indical d work-b F-Dr <br /> AI <br /> REED SEALED & INTACT VfA � •�� <br />