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( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvirotimental, Inc Date 2-rr� Page of <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467 1006-Fax(209)467-1118 <br /> Project Manager <br /> Client ( ( r L a W N S ri M k' J/',�- Tests Required <br /> 0 ZZ Phone Number L <br /> 17 da <br /> Samplers (Signature) r o Invoice <br /> �_��J� AGE <br /> Protect Name i frit W"" Client ❑ <br /> Sample Location Sample Type No of ' <br /> Number Description Date Time WaterAj{ Solid Conts tib Notes <br /> Comp Grab <br /> Zf <br /> 11 T4 <br /> no in us e y ( ' ature Receivedy ignature Data Ime <br /> �' <br /> Relinquished by (Signature) Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile laboratory for field analysis (Signature) daterrime <br /> Dispatched by (Signature) Date/Time R nr for Laborato by Date/Time <br /> Method of Shipment Laboratory Name / 1 <br /> Ver �f rt � � <br /> Special Instructions I hereby authorize the performance of the above Indicated work <br /> AM <br />