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=b = = 4r <br /> CHAIN OF CUSTODY RECORD <br /> Advanced Date -7-it-W Page --L of <br /> - GeoEnvuonmenta.l, Inc. Q- <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> Project Manager Tests Required <br /> nt <br /> ClieU Cv� FoJ Fad ff <br /> Phone Number <br /> CC.. <br /> Samplers. (Signature) Invoice <br /> AGE <br /> Project Name Client ❑ <br /> Sample Type v <br /> Sample Location pate Time Water Sohd No of �� Notes <br /> Number DescriptionCompGrab Alr GUf1tS <br /> 1 42579 <br /> ��w ` , to `7-/v 4xr f>33 1 z <br /> �c 42580 ; <br /> 427584 <br /> t 42582 <br /> 42583 ' <br /> tr � ;L40 <br /> 42584 <br /> 5� Iv 42585 <br /> y (Signature) <br /> Relinquished y Signature)), <br /> ece ve 5�4 F i <br /> Relinqu�s ed by (Stgnat re) Received by (Signature) t]atelTime <br /> Ir <br /> inquishew y (Si �`"; r_, 'i y— Rgcelved by Mobile Laboratory for field analysis (Signature) t)atel7ime <br /> I <br /> f]tspatched bar (Signaf ,, OatelTFina c Fve¢for Labora ry by DatelTime <br /> + yr <br /> Method of Shipment7�61141,fie <br /> , � � ;. � Ar k'CIQ <br /> Special Instructions I hereby authorize the performance f tjq above Indicated work <br /> ( ` ( �b Li <br /> tit} Qrr,2� J c�J' G�1.u/` � ti�c.� err C-- c,� <br />