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1 � <br /> Advanced CHAIN OF CUSTODY RECORD <br /> - �? Page <br /> Inc. Date/o <br /> „:- GeoEnvironmental, <br /> r <br /> .' .; of Northem Califorma <br /> 78012 801l <br /> 1 OD3 West March Lane,Suite A-Stockton,California-96207-(209)9564M-Fax(209)9560700 <br /> Client SPro1ect b4an ager Tests Ret 78013 <br /> Phone Number ,�Q / 78014 <br /> hW, >' /�`� <br /> Samplers: (Signature) l / Invoice: <br /> AGE [[(]� C <br /> Project Name 6t WAAL" A4q& / �� Client ❑ <br /> ' <br /> Sample Location Sample Type No <br /> Date Time Water Solid .of �n�✓ 78015 <br /> Number Description Comp. Grab. Air Conis. <br /> 7 - 2 1l ►o ,/ off- <br /> 78016 <br /> 'Z 62_—2Zz_. _ I Z-= '� :�-- 78017 <br /> lb - Of q ✓ t � 78018 <br /> ti �bUD ✓ <br /> Ra1i u y: ( r nal e r ad Y. gnature ` � , / D e/T(me <br /> Relinquished by:(Signalure) Yed CS(gnal re) DatelTlme <br /> t MG MMMii) 5--OGY -1717- <br /> Relinquished <br /> r1 rRelinquished y:(Signatur II to <br /> Lab sry f field analysis:(Signature) DatetTlme <br /> a�waas� <br /> nn <br /> Dispatched by: (Signature)' ' SPAS ItBScl1* ate/Tlme Received for Laboratory by: Dale/Time <br /> Method of Shipmknl: Laboratory Na e <br /> Special lnsllruction&.J I hereby authorize he performance of the above indlcaled work. <br /> OS$ CiCCC Cjjj `'y� i <br />