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CHAIN OF CUSTODY RECORD <br /> Advanced <br /> GeoEnyironmental, Inc. gate 41-+5-� Page �--.- of <br /> - �-- <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-11113 <br /> Client Project Manager Tests Required <br /> Q 11 C" <br /> Phone Number <br /> - `it,-7 - 100 <br /> Samplers (Signature)00, Invoice <br /> � AGE <br /> Project Name ,rtr Client ❑ <br /> Sample y9pe No of 2� <br /> Sample Location Date Time Water Solid t Notes <br /> Number Description Comp (arab Air Conts <br /> 53994 <br /> 3 x ` <br /> �( 53995 S <br /> n w�f f r7 W �. i 1-15--t�ca 0q5-0 �` "`� r ' <br /> 11 IS0�-' ` <br /> ,,// 1'� 5399s1� !` <br /> Iwti f i� I s e feu - LI �' X 997 r <br /> it 51 1 k kSoo ,Mw�S �j45-ft> 135 X F _ 53998 <br /> / I i5oo '( +-f5-�� 1 y2� X 53999 <br /> e r s e y tg atu ecerve y tgnature aaterTime <br /> Relinquished by tgnature 4f li Al <br /> a a) bate/Ttma <br /> V l.' L =i4J`UTl I <br /> n n M} +Tt 1 <br /> Rsltnquis ISlgaature) t HUM _ fl red by Aildbtle- oratory for held analysts (Signature) !]ate/T me <br /> il+l S fs SIL>>I I _ r l r'iJt�il'll.. <br /> �� <br /> Date/Time Receiv. d for Labora y oatelTtm�e7 <br /> Dispatche i� A tat .t4l' I__ t !�i :1 //�/ �✓{{�c�'^.7 <br /> I <br /> aboratory Name <br /> Method of Shipment I <br /> i hereby authorize the performance of the above Indicated work <br /> Special Instructions <br /> I <br /> ri <br />