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Advanced CHAI � OF CUSTOD RECORD <br /> ,�- GeoEnvironmental, Inc. Date Page of <br /> of Northern Caltfonua <br /> 1803 West March Lane Suite A Stockton California 95207-(209)956.0264-Fax(209)956-0700 <br /> Client' Project Manager Tests Required <br /> F OL �'rpcc <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> f. ? / AGE [� <br /> Project Name bt /4 Client ❑ <br /> Sample Type I <br /> Sample Location Date Time Water Solid No of Notes <br /> Number Descriptioni Comp Grab Air Ct7ntS <br /> Nio 3 -rq 7 z�'° ✓ 3 — a- <br /> At A313-1 7 X3 <br /> Y- <br /> /3-*T7 <br /> m4j& f <br /> e rrrquls e by (Signature) ece—iv e y ( ignature Dat /Time <br /> fTne <br /> ��7 <br /> Relinquished by (Signature) Race irled y ig lure) 5 r Date <br /> Y <br /> J %<,C <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> I <br /> Dispatched by (Signature) Date/Time Received for Laboratory by DatelTtme <br /> Method of Shipment Laboratory Name <br /> Special instructions I hereby authorize 1 e arformance of the above indicated work <br /> V — <br />