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r <br /> j Advanced CHAIN OF CUSTODY RECORD R <br /> Page' Geoate `OZ.G2- PaEnvironmental, Inc.Ync. g of <br /> 837 Shaw Road - Stockton, California-95215- (209) 467-1006- Fax (209)467-1118 l9�.� C)j' <br /> Client -Rfe'ect M a er <br /> Tests Required <br /> Pilo e Numb r <br /> Samplers: (Signature) Invoice: <br /> ProjectName �G- �( � ([iS �� f AGE <br /> -- }� Client tj <br /> Sample Type ` <br /> Sample Location Date Time Water Solid N° °t Notes <br /> Number Description Comp. Grab. Air Conts. <br /> -3 D kow 0 Lf-0-rol-.14 V-7 0 1�-D <br /> l ed (Si na ure ece ve y: gn—at ure — <br /> Date/Tim <br /> Relip (shed b re L�1 �DZ ✓C� <br /> q r ( ) Received by: (Signalure} <br /> n "�� Datil rma <br /> 4 I <br /> Relinquished by: (Signature) Received by Mobile Laboratory for fluid analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Received forLabor tory: rne Dtr/-ic( . <br /> Method of Shipment: Labpstory Na Ma <br /> ( tea .N "/ I -k� l/ l'it1 - 'I i-S <br /> Special Instructions: I h4ar "1fhorixe the parrb manta of tf►e above Indicated woit.. <br />