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7?671 <br /> 0 0 ®312 <br /> Advanced CHAIN OF CUSTODY RECORD <br /> Date ! Lb3Page of I <br /> ----_� GeoEnvironmental, 1nC <br /> u837 Shaw Road - Stockton California- 95215 - (209) 457-1005 - Fax (209)487-1118 <br /> Client r L Prot Managta Tests Required <br /> SL'( -0A1 <br /> Phone Number � <br /> 1-tC' 716.0(.; <br /> Sam p (Signature) Invoice <br /> AGES <br /> Project Name ell, yc <br /> rL <.k Client ❑ <br /> Sample Location Date Time Sample Type Scam No of Notes <br /> Number Description Comp Water <br /> teAir COnts '�� � <br /> U5-12/I Lo Ir-3 ��,T 17-1 Lt-� J 1414 1/1 A <br /> 1p-3 <br /> � .3 i( j'44vL 11A �Z <br /> Lr ki / A/ <br /> I lL �G L3�" t+ � j�Z <br /> LFU ! (in <br /> I A/ <br /> S i r U T7 LE S <br /> lZ�LO,3 Z A / Dale/Time <br /> quos a y {Signature) aX�eF g t �J 7 1luc c <br /> R inquished by (Signature) s , Received by (Signature) Datalfrme <br /> ICFlC <br /> Relinquished by {Signature) rr1�ltI�ilJRlobt aboratory for Held arralysta (Signature) �` DatelTurta <br /> BAll SPACE ABSENT CONTAINERS `/� <br /> DECHLO�'fED IN RESER <br /> Dispatched by (Signature) WAS if O&G METAIS I OTRA 'ma Recervad for Laboratory by Date/Time <br /> PRESERVATION <br /> Method of Shipment y Laba�atyy Nam <br /> t hereb authorize the performance of the above indwats:cl v nr <br /> Special instructions sc <br /> �-' HEMSEALED &INTACTVlA 1 ov h • <br />