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CHAIN OF CUSTODY RECORD <br /> Advanced Date Page y of <br /> CO2 <br /> GeoEnvironmental, Inc. <br /> 837 Shaw Road- Stockton,California-95215- (209)467-1006- Fax (209) 467-1116 <br /> i i " <br /> Project Manager / ii Tests Required <br /> Client cc fgt,,JrA_ <br /> Phone Num <br /> Samplers: (Signature) krt-e— Invoice: <br /> PiaL/ 1 AGE <br /> Project Name 2 ; �- S ' \ �N,�y` Client <br /> I> ewe. <br /> a <br /> Sample Type No. of Notes <br /> ��u <br /> Sample Location Date Time Water Air Solid Coats. <br /> Number Description Comp. Grab. V <br /> P� W2,0zs 133 ' x <br /> 63 5 <br /> U.1u I2s� X 1 0) <br /> B3-t5 <br /> 133-2.0 f % <br /> iXIX <br /> X S <br /> eceive yr ignature' Date(TI <br /> eingws a y: natur <br /> Date/Time <br /> Relinquished by: (Signature) Received by: (Signature) `'�r }, <br /> Dale/Time <br /> Relinquibhatl tiy: (Signature) Received by Mobile Laboratory for field analysis:(Signature) <br /> Dateflime Raoaiwd for Laboratory by: ..i i DatelTime <br /> Dispatched by: (Signature) .✓ � - _- _ <br /> Laboratory, <br /> Method of Shipment: <br /> C �✓ <br /> I hereby authorize the performance of the above indicated work.. <br /> Special Instructions: /) <br />