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! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! <br /> ( _ Advanced CHAIN OF CUSTODY RECORD <br /> ,. : <br /> GeoEnvironmental, Inc. Date 1 p Page , ( of�_ <br /> Q� 012 <br /> 837 Shaw Road - Stockton, California- 95215- (209)467-1006- Fax (209) 467-1118 <br /> ClientP97a <br /> ' Manag <br /> �YL �� � E Z" # Tests Required <br /> Z��-- <br /> P ne N tuber <br /> Samplers: (Signature) Invoice: <br /> Project Name �'�� -� AGE <br /> o let Client E] <br /> Type Typ <br /> Sample Location SampNo. of <br /> Number Description Date Time Water Solid Notes <br /> p Comp. Grab. lglr ConiS. <br /> \A YJ I I <br /> 4, 11-/ X �J <br /> elinquis e ( gnature) ccived y: ignature D te[Time —' <br /> Relinquished by: Signature) Received by: (Signature) Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Date(Time Re mr Laborator D te/Time <br /> a?/ ,05 ge� <br /> Method of Shipment: oratory Name ,.�ff ff <br /> cr, �kQ <br /> Special Instructions: tib+ J� —( �/ Itr I hereby authorize the performance of the above indicated work. <br /> f I! ED <br /> GOOD CONDITION'AppROpTg <br /> TAINERS____ <br /> DECHLORINATED IN LAB—PRESERVED IN LAB____ <br /> RLQ SEALFD_&1NTACLV1A_ <br /> PRESERVATION <br />