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Ili �r � M M <br /> • <br /> j Advanced CHAT F CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date Z Page 2 <br /> 837 Shaw Road -Stockton, Californla- 95215- (209)467-1006 -Fax (209)467-1118 <br /> Client Project Ma ger <br /> Tests Required <br /> Phone Number <br /> rs (Si nature) Invoice <br /> Project Name AGE [n-' <br /> Client ED <br /> Sample Location Sample Type <br /> Of o <br /> Number Description Date Time Water Air Solid N No O Notes <br /> Comp Grab <br /> �I t <br /> loZ �- r <br /> 1221 <br /> e in is e y net e <br /> ace ve y agnature <br /> Oate/Time <br /> cyo3L/� <br /> Re nqur a by ( ignatu Received by (Signature) Date(Ttm <br /> lb <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) <br /> Date/Trrne <br /> Dispatched by (Signature) Date/Time R void for abo to <br /> ' Dateffime <br /> Method of Shipment L o No <br /> Special Instructions I hereb aut riza p rformanca of the above indicated work <br />