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Advanced GeoEnvironmental, Inc. www.advgeoenv.com CHAIN OF CUSTODY RECORD i <br /> ® 837 Shaw Road,Stockton,California 95215 •Phone(209)467-1006 • Fax(209)467-1118 Date: 73-1-7')y1L} Page_A of <br /> 381 Thor Place,Brea,California 92821 •Phone(714)529-0200•Fax(714)529-0203 <br /> " ❑2318 Fourth Street,Santa Rosa,California 95404 •Phone(707)570-1418 •Fax(707)570-1461 Analysis Required <br /> ❑ 395 Del Monte Center,#1 11,Monterey,California 93940 •Phone(800)511-9300 a Fax(831)394-5979 <br /> Project N me Project Mana er`` <br /> 1 <br /> Client Sam J/ler(initials&signature) u <br /> 1. _r <br /> Lab Project No.: L <br /> Invoice to: ❑ AGE ❑ Client <br /> Sample ID/Location/Description Date Time Matrix Number Notes <br /> _l INCE <br /> Relinquished by: Date: Time: laboratory: <br /> Courier: Received by: Date: Time: <br /> Relinquished hy: Date: Time. Received by: Date: Time: <br /> Relinquished by: Date: Time: Received by: Date: Time: <br /> r , <br /> Requested Tum Around Time(circle):Q4 hours N hours 72 hours 5 days(standard) Other: _ Matrix Codes: A Air W=Water S=Solid <br /> Special Instructions to lab: I hereby authorize the performance of the above indicated work. <br /> Global ID: <br /> Gcutracker F:UF to:0 geotracker(aadvgeoenv.com El �' <br />