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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvlronmental, Inc 0'319aa07-- Date t10 C� ;> Page of Z <br /> 897 Shaw Road - Stockton California 95215- (209)467 1006 - Fax (209) 467 1118 <br /> Client � � Project Mana er <br /> — ----- 7 1 Lk Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> � v <br /> Project Name Tk 13r �� b AGE Q5— <br /> Client C3 <br /> Sample type � <br /> Sample 1 Location pate Time No of <br /> Number Description Water Air Solid Conts Notes <br /> Comp Grab y <br /> rte �4/ �lL�6f��� 1Z14d3 /SZ f <br /> -o,cvJ(fl3if fI 11 <br /> o <br /> t/ #11V{ <br /> t L <br /> e uis e y ( e nature) Wece ve y (signature) <br /> bate/Time <br /> - 12/0 f 7Va <br /> Re rnqu" y ( r ture) Received by (Signature) DatelTime <br /> COOD CONDITION ROPItIATB <br /> Relinqu liP, Rowl eceived by Mobile Laboratory for field analysis (Signature) DatetTime <br /> f R S [.AIT Ia58RVf3p IN LAB <br /> WAS 4ZO&O I METALS I OTHER <br /> f]rspatc �' i e � _ OatelTiine rteoe wd! Laboratory by telTime <br /> Method of Shipment Na e <br /> RRECD SCALED & INTACT VIA CGe�d(/r?�h r <br /> Spacial Instructions U i fiareb authorize 1 0 performance of the a ndicated work <br />