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( Advanced CHAT OF CUSTOD ECORD <br /> GeoEnvironmental, Inc. Date Page Of <br /> 837 Shaw Road-Slocklon, California 95215- (209) 467-1006- Fax (209) 467-1118 J <br /> Client Project Manager Tests Required <br /> one Imber <br /> Sam rs (SI ature) Invoice <br /> Project Name ut� AGE 2 <br /> ( Client ❑ <br /> Sample Location Sample ype <br /> Date TimeNo of <br /> Number Description Water Air Sobd Conts Notes <br /> Comp Grab <br /> I <br /> e in ui ed Ir( g at e} Received by (Signature) ale/Trme <br /> Relinquished by (S gnature)U Received by (Signature) D elTime <br /> I <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Dalef ime <br /> Dispatched by (Signature) Date/Time Received for Laboratory by DatelTime <br /> 4Z�11Method of Shipment Lab ory me <br /> f Special Instructions I hereby a-1 rl t a performance of the above Indicated work <br />