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4 Advanced CHAIN OF CUSTODY RECORD <br /> -= GeoEnvironmental, Inc Date t�8 Page of S <br /> 4005 North Wilson Way-Stockton,Califomia-95205-(209)467-1006-Fax(209)467-1118 <br /> x �e <br /> Client M 1 �� Project Manager <br /> Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> Project Name AGE � <br /> Client ❑ <br /> Type Typ <br /> Sample Location SampleNo of <br /> Number Description Date Time Water Air Solid Cants <br /> Comp Grab <br /> 90055 <br /> lbs° ✓ o� H 98056 <br /> x -46 10 3v 96057 <br /> -51, ro3� 96058 <br /> 98059 <br /> 5M06-3�� 6° ✓ 90061 <br /> e inq he y ( ignatureecei e y (Signature) all'3� <br /> fte �/p <br /> Refrnqulsh y Sig re) Nkc-pwed by (Stgnatur PIT_ DaleJTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysts (Signature) Dater ime <br /> Dispatched by (Signature) DalelTtme Received for Laboratory by DatelTime <br /> Method of Shipment I .s Laboratory tt le <br /> 4%z*'q G'0 <br /> Gaj <br /> Special inslrucltons I hereby authorize he performance of the above indicated work <br /> WAS ON I M[TALSI OTHER <br /> 131000 CONDITION APPROPRIATF <br /> r <br /> [ftAD SPACE ABSENT- _ CONTAINERS <br />