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�� � f� ii � ff� f� �� � tfi�■Iflt ■1■IA1 7HAIN <br /> Advanced � � OF CUSTODY RECORD <br /> -_ GeoEnvironmental, Inc Date o-7 Z1--4Pa9e --Lof <br /> of Northurr Culrfonua <br /> 1803 West March Lane Suite A Stockton California 95207 (209)956-0264-Fax(209)956-0700 <br /> Client � P L� Project Mana er <br /> � y,G r � Tests Required <br /> Phone Number[- `o <br /> Samplers (Signature) Invoice <br /> Q AGE <br /> Project Name } >v Client ❑ <br /> �t4 L �. 15 ��.►�1]L C S �'}}�T1 fiYVl <br /> Sample Type <br /> Sample Location No of v <br /> Number Description Date Time Water Air Solid Conts Notes <br /> Comp Grab <br /> dal -�35 r <br /> 2-5 l.��r J� �� a 5 --l5 10' � , <br /> e ws a y�r(`Sign�ature) Received by (Signature) '7 Date/Time <br /> (A�l 7-;Z --q <br /> Relinquished by (Signature) Received by (Signature) + Date ITi e <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Re i e for oral ry b �^ a4+T r�ne <br /> Method of Shipment Laboratory Name II <br /> C� Qt�Aml�-0 1 I 1 Jn-t'j,1 itd <br /> Special Instructions I hereby a nze the performance of the above indicated work <br />