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V�PG r~�oTHr— <br /> ICS ✓ PRESERVATION <br /> Advanced GOAD CONDITION " ' APPROPRIATEAjlq • CUSTODY RECORD _ <br /> { <br /> .�_t0D SPACE ALW. CN� L.`� Date Page rf <br /> GeoEnvironmental, Inc. - - <br /> ' <br /> 4005 North Wilson Way-Stockton,California-85205-(209)487-1006-Fax(209)487-1118 <br /> i 33414 <br /> Project Manager Tests F� <br /> Phone-Number i <br /> , 3416L_� <br /> Samplers: (Signature) <br /> Project Name - ' <br /> i <br /> sampl Type r 33419 <br /> Sample Location Date Time Water Solid No.of ! ; <br /> Number Description Comp. Grab. Air Conts. <br /> PDAS1 1043 <br /> 1 <br /> Nlrlme <br /> RerrhqUished IJV: (sionat Received by: (Signature) <br /> aislTime <br /> Relinqu s s by: ( gnature Rscelved by: (Signature) <br /> Relinquished by: (Signature) Received by Mobile Laboratory for lield analysis:(Signature) DatslTims <br /> Dispatched by:(Signature) Dais ime Received ar • oratory Dat <br /> atIIms <br /> Method of Shlpm nt: LaboratVT�61t� <br /> Special Instructlon1.0 i hbauthorize the perlorated work. <br />