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, � � tttiitI f � 4r _ <br /> 'Lfi I <br /> i Advanced CHAIN OF CUSTODY RECORD <br /> = Z Z L <br /> GeoEnvlronmental, Inc, Date Page of,���� <br /> 837 Shaw Road - Stockton, Caftforrua- 95215 - (209) 467-1005 Fax (209)467-1118 <br /> Client1 Project Manager <br /> � Tests Required <br /> -- Phone Number <br /> Samplers, (Signature) InvO1Ce <br /> Project Name c{� – � j y ' -_ L — AGE <br /> Client ❑ <br /> Sample Location Sample Type <br /> No of <br /> Date Time <br /> Number Description Water Air Solid Conts �� Notes <br /> Comp Grab <br /> VIC <br /> OiQ AL4 <br /> IGEIt° PRESERVATION <br /> GOOD CC <br /> HEAr3SP k0BABSENP CON NE <br /> 3` - ,rTi'n1NLAB � <br /> PFZ -n <br /> IT <br /> Belo ts e by�Sig ature) ecetve y rgnature / Date/Timer l T4-r- <br /> Relinquished by (Signature) Received by (Signature) <br /> pate/Ttmo <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date[Trme <br /> Dispatched by (Signature) Date/Ttme Aecerved for Laboratory by Da a/Time <br /> VZA <br /> Method of Shipment Laborato Na � <br /> Itf c '6";7 ( 2' <br /> Special lnsttucbons I hereby authorize the performance of the AbAve fndt t rk <br /> Ctx1 L 4"'1+ i e- be C 1 <br />