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Advanced CUSTODY REC O N CHAIO FRD <br /> _ -=- GeoEnvironmental, Inc. Date zl3�.� Page 2 of <br /> 837 Shaw Road - Stockton, California-95215- (209)467-1006- Fax (209)467-1118 <br /> Client r G Fo's 4— Project Manager l Tests Required <br /> Phone Number <br /> Sampl s (Signature) Invoice <br /> Project Name AGE�- <br /> ,`,� Client ❑ <br /> Sample Loc tion Sample Type No of ` <br /> Number Description Date Time Water Air Solid No <br /> Q ?� Notes <br /> Comp (arab <br /> JAW r µ�t.�1 l L�3�3 it <br /> A jai /49/Z <br /> 12,16 <br /> Relinatfis e y�te) Receivedy ignaturo Date/Time <br /> R fished by (Signature) Received by (Signature) DatelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Tims <br /> Dispatched by (Signature) Date[Time Received for Laboratory by DalelTime <br /> Method of Shipment .. Labort�y7'1117— <br /> Special Instructions � I hereb uthofize the performance of the above indicated work <br />