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M If M M M M M- EEL- <br /> Advanced <br /> CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date Page to <br /> nJ'Nnr7lrenr Califrn-rri,1r <br /> 1803 West March Lane,Suite A-Stockton, California-95207-(209)956-0264-Fax(209)956-0700 <br /> Client ��� L Project Manager <br /> ') 1,4' Tests Required <br /> Phone Number <br /> 0o r <br /> Samplers: (Signature) Invoice: <br /> Project Name AGS EJ <br /> H ti <br /> Client ❑ <br /> Sample Location Sample Type t / <br /> Number Description Date Time Water Solid No. of i� —_f�rnen <br /> p Comp. Grab. Air Conts. <br /> x /l �.eet�,Co- 2��"Eu�4-3i�s��LrCs�e f <br /> g Z'20 x-(vel <br /> T;VRf®r, <br /> ''�i t <br /> e, <br /> e inquts y: 1ign,, re) ece ve y: rgnaIure f � ❑ate <br /> /gqpJ <br /> lTime <br /> Relinquished by; ( gna ure) Receive by; (Sig ature) <br /> Date/Time , <br /> Relinquished by: (Signature) Received by Me Laboratory for field analysis:(Sig Idre)' , <br /> lr F 1.. P. Date/Time <br /> Dispatched by; (Signatutel J° <br /> UPON PON R��ve,d,i�'rfra� y y Date/Time <br /> ( `1 jt Vrff I C borator b <br /> (�: .Q PA <br /> Method of Shipment: r Laboratory Name <br /> Special Instructions: 1 hereby authorize t e performance of the above Indicated work. <br /> l./CJ <br />