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Advanced CHAIN O = CUSTODY RECORD <br /> GeoEn�ironmental, Inc Date le Page � of <br /> ,=- `� ~: <br /> 837 Shaw Road-Stockton, Cahtornia - 95215 - (209) 467-1006- Fax (209) 467-1118 <br /> Chen, Project ManagerIL Tests Required <br /> 4 <br /> Phone Number <br /> A L SKI <br /> Sas (Si ature) Invoice <br /> Project Name , AG <br /> PC- ClleE <br /> Sample Type / <br /> Sample Location No of / <br /> Date Time Water 5ajld / Notes <br /> Number Description Comp Grab All Conts <br /> Gl— <br /> Je PRESERv ON <br /> 0017 COPillI'I'TON APPROPRL LTE <br /> ECHLORWASEDTATLAB_PRESERVI D IN LAB <br /> eliZ Received by (Signature) a /Time <br /> Relinquished by {Signature) V Received by (Signature) lbaterfirria <br /> i <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatatTime <br /> i <br /> Dispatched by (Signature) Date[Time Received for Laboratory by Datetrime <br /> Method of Shipment La ry <br /> Special Instructions I hereby authorize the pert (mance of She above indicated work <br /> f P 1 �=D liy r.?a-�r �— �)i I P���f� ✓� <br />