Laserfiche WebLink
�-� CHAIN OF CUSTODY RECORD <br /> j ) Advanced Date Page of <br /> GeoEnvironmental, Inc. 0501157/ <br /> 837 Shaw Road- Stockton, California- 95215 - (209) 467-1006 - Fax (209) 467-1118 <br /> Client <br /> /� Project Manager Tests Required <br /> �V,��r' ��� �� ��"�' �a J'`�e-- faj <br /> Phone Number <br /> Samplers: (Signature) ' Invoice: <br /> AGE.0 <br /> Project Name Client ❑ <br /> Sample Type No. of Nates <br /> 'T�I <br /> Solid <br /> Sample Location Date Time Water <br /> Number Description Comp. Grab. Air / Conts. <br /> Nwao --io <br /> Al 4 /OZ? / �� Date/Time —+— <br /> Si ature ecerve y: ignature =/, ' <br /> elin1q��ui//�e y: (Sig ry �rad '"r�.1� <br /> Idlll� + �f f J Date(Time <br /> Relinquished by: (Signature) Received by: (Signature) <br /> Date/time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) <br /> -/-; <br /> DatefTime Rec ived for Laboratory b rt / ime <br /> Dispatched by: (Signature) K <br /> t <br /> Laboratory Name <br /> Method of Shipment: - �✓ try,(jw — <br /> IHereby authorize the performance of the above indicated work. <br /> Special Instructions: <br /> GOOD CONDITION �APPROPRIA'I$ / - - — ✓ <br /> CON lA1NbK5_ <br /> DECHLORINATED IN LAB—PRESERVED--PRESERVED IIS LA$.,,,.,.,... - — - <br /> vnsa - <br /> PRESERVATIO-K_ <br />