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r �r r rr rr rr rr r � r r r rr rr r rr� r <br /> ( `Z Advanced CHAIN OF CUSTODY RECORD <br /> --- �'i GeoEnvzronrnental, Inc Date Page ot_. <br /> 4005 North Wilson Way-Stockton,Caldomia-95205-(209)467-1006-Fax(209)467-1118 <br /> ClientPro€ems Manager-EiLrac <br /> Tests Required <br /> — � /m aae�011"2 I-- <br /> e P;h7 Nu ber <br /> ��r 4 <br /> Sa pl (Signature) Invoice <br /> Protect Name AGE Q <br /> + Pr-1 <br /> t'� � ,� �� Client <br /> Sample Location Sample Type ' <br /> Date Time olid No of <br /> Number Description cpmR Water <br /> Air Cants � � Notes <br /> 5244 <br /> 'v <br /> MyJ 5116 _ �5' 7. j5o k rr <br /> KA0 f� �� �—� 0.06 � f <br /> 5 �� �� „� - ln;5 k r <br /> rr -- �$' Q,jI"� 1 r <br /> MW070 70 loop 71 0C �- r ►� <br /> 76 <br /> e inq a y ( ignatu a ecel e y 1g nature <br /> ��5}�!t✓ � f t7 terrime <br /> Relinquished by (Signature) Received by (Signature) L1�G� atefTim� <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Datefrime <br /> Dispatched by (Signature) Date/Time Received for Laborelor by Date/Time <br /> L J,A) <br /> Method of Shipment Laboratyroame <br /> Special Instru719 '5dt"43 <br /> I hereby orize the performance of the above Indicated work <br /> Iif f <br /> CL 5 <br />