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tililll>• tffliffll• ■lam � �� � � t, � � � � � � � I• � � !• <br /> Advanced CHAIN OF CUSTODYMECORD <br /> GeoEnvrrorimental, Inc. Date 6 Page of <br /> 837 Shaw Road- Sto(kton, California- 95215- (209)467-1006- Fax (209)467-1118 <br /> Client r Project Man a er <br /> ! Tests Required <br /> one Number <br /> •zacl L16-T- I 0 0 <br /> Samplers (Signature) Invoice <br /> Project Name r � AGE <br /> �� E f i��.L� I'7 �� � Client ❑ <br /> Sample Location Sample Type No of ' <br /> Number Description Date Time Water Air Solid Conts Notes <br /> Comp Grab <br /> A IA- <br /> Ak)- 15 1 112 6 1C <br /> 4Al <br /> OX 4 <br /> Aw--z �,s <br /> �w zure) Received �igna�tubre "?� X <br /> Da elTim <br /> 1.6L 3� <br /> Relinquished by (Si nature) Received by (Signature) Dale rme <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Daterrime <br /> Dispatched by (Signature) Date/Time Received for Laboratory by Datefrime <br /> t -(-7-1 <br /> Method of Shipment Laboratory N e <br /> C � - 4 L <br /> Special instructions ty � ��� I hereby authorize the performance of the above indicated work <br />