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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc Date 1-3 Page Of <br /> 837 Shaw Road-Stockton California- 95 <br /> 215 (209)467 1006- Fax (209)467-1118 <br /> Client CIT Proma Mana er t 'f� <br /> � Tests Required <br /> Ph a Number <br /> Samplers (Signature) Invoice <br /> Protect Name <br /> -� AG E <br /> Client ❑ <br /> r <br /> Sample Type <br /> Sample Location Date Time Water Solid No of Nates <br /> Number Description Comp Grab Air Conts <br /> 606 <br /> 12,35 j <br /> elinquis e y Siallaturel Receivedy ignatureIr /0� l <br /> at8 rne <br /> Relinquished (Sign ture) Received by (Signature) �r' "4 /`Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Data/Time Received for Laboratory by (( DalelTime <br /> Method of Shipment Laboratory None, <br /> Special Instructions I hereby authorize the performance of the above indicated work <br />