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�r �� ttttttttttt �r_ t1!■■ � ri � I♦ l♦ _ <br /> y Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. 00 Date Page of <br /> 837 Shaw Road Stockton, California-95215-(209)467-1006 - Fax (209)467-1118 <br /> Client Pro�ect Manager <br /> L`7 7 6 T 7"� Tests Required <br /> Phone Number <br /> Ar,r t1 <br /> Samplers (Signature) /� Invoice <br /> Project Name �) AGS Ua <br /> Client E:]Sample Location Sample Type <br /> Number Description Date Time Water Solid No of <br /> p n <br /> Comp Grab <br /> Air i Conts Notes <br /> s x <br /> el"i q ti- y Lig—nature)W' ecerve y rgnature <br /> Relinquished by (Signature} Reserved by (Signature) <br /> Data/Time <br /> Relinquished by {Signature} Received by Mobile Laboratory for field analysis (Signature) <br /> Date/Time <br /> Dispatched by {Signature} Data/Trme Reo iv d or Laboralol r <br /> ate(Time <br /> Method of Shipment ,l� ;g f� 'Sr <br /> La oratory Na�ery <br /> Special Instructions <br /> I hereby authorize th performance of the above indicated work <br />