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Advanced _ CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date -27-Q4 Page of 5 <br /> 637 Shaw Road-Stockton, California-95215- (209)467-1006 - Fax (209)467-1116 <br /> Clientb Lla% Project Manager pp Tests Required <br /> ' Phone Number <br /> Samplers: (Signature) �pj C' V Invoice: <br /> Project Name Q KIS f�Ct re-p �— - AGE X <br /> u( t J� n CIIenIC <br /> Sample Location Sample Type , �° c)� <br /> Number Description Date Time Water Solid No. of Q ;� Notes <br /> Comp. Grab. <br /> Ai contS. <br /> B3-40 1`x6 3 @ qV' 6-7Z-oq ` 's Z <br /> 13'3 W ur .�rvw �,,�rl 3ivas / X � X <br /> �Rr'i(11 o. v' 1131 1 � DC6 <br /> 13q—PD k to 0143 <br /> t3y-15 It tt <br /> It it0,- Z4)% <br /> 3 -25 .2-5 ;r SB / I X X �( �►., <br /> Relinquished y: Ignature) Receive9W. Ignature Date/Tim <br /> [ 'U. <br /> Relinqu had by: (Signature)__ _ _ _ .Received by: (Signature) - 1p'-r7i Dataf 16-4D <br /> - Oete/Tlme <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) 5A <br /> i Date/Time <br /> . _ to <br /> Dispatched by: (Signature) _ - Date/Time Received for Laboratory by: ) \ ,h - Date/Time <br /> Method of Shipment: La ory Name <br /> �i ovice.'�IGtt r -Tc-C-tf <br /> Special Instructions: - I hereby authorize the performance of the above Indicated work. <br />