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r it i ` r • 1 r i a r i r 1� y <br /> fCHAIN OF CUSTODY RECORD <br /> Advanced Date 31 98 Page Z of Z <br /> -_-_" GeoEnvxronmental, Inc. <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 13538 <br /> 3S 7Q sa <br /> Clientt( Project Manager , r <br /> � � d � Tests Required <br /> Phone Number X� <br /> Sam p ers: (Signature) �� Invoice: <br /> y U <br /> C� AGE [Y <br /> Project NamerGorN A4Y Client ❑ <br /> Sample Type <br /> 0� <br /> Sample Location No. of /� Notes <br /> Comp. Grab. <br /> Number Description Date Time Water Air Solid Conts. �b <br /> .[ V wi-12 328 <br /> Relinquished ( na c e y: rgnature �(J,:—uf 9 Tim <br /> 9�O <br /> Relinquished b Si aiure R rued b Si n lur D DateTime <br /> q Y ( 9 f y: ( 9 ) <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) DatelTime <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Date rime <br /> Method of Shipment: Laboratory Name <br /> FL <br /> Special Instructions: WAC G&G M TAIL OTHER <br /> { I hereby authorize the rf mance f the ov Indicated work. <br /> r VYtJ UOIt] IYICIYdJ UFtll fi <br /> r <br /> GOGO CONDITION APPROPRIATE <br /> KAD PACE J <br />