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AdvancedGeo CHAIN OF CUSTODY RECORD <br /> Phone: (800) 591-9300 <br /> Environmental Fax: (888) 445-8786 <br /> Analysis Required <br /> DATE: Z Q PAGE OF <br /> Ao Employee-Owned Comp my <br /> Project Name r Project Manage <br /> Client Sampler 'nitials&raturt <br /> i <br /> Invoice to: AGE ❑ Client Lab Project No.: <br /> Sample ID/Location/Description Date Time Matrix Number Notes <br /> 00, Out _ i6ti-si� Well <br /> Relinquished by: f I Date: Time: Laboratory: <br /> 1 �C� <br /> Courier: L Rece ved by: Date: Time: <br /> �a� 2-3 . <br /> Relinquished by: Date: Time: Recei y: _ Date: DMe: <br /> - <br /> 23 1250 ` 2-2 I`i I -5 <br /> Relinquished by: Date: Time: Receive Date: Time: <br /> Requested Turn Around Time(circle): 24 hours 48 hours 72 h rs days-(s la"Bard) Other: Matrix Codes: A=Air W=Water S=Solid <br /> Special Instructions to lab: I her uthorize the performance of the above indicated work. <br /> 2 -t-C-C / <br /> Geotracker EDF to: ❑ geotracker@advgeoenv.com ❑ Global ID: / <br /> Pane 7 of: <br />