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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date 5-2-+- Page I at 3 <br /> ...... 837 Shaw Road- Stockton, California- 95215-(209)467-1006-Fax (209)467-1118 <br /> Client Project Manage <br /> �a r I I Tests Required <br /> 411 <br /> Phone NL4mber <br /> oe <br /> Samplers: (SignaWte) Invoice: <br /> AGE <br /> Project Name Client <br /> Sample Location Date Time Sample Type Solid No. of Notes <br /> Number Description Water Air Conts. <br /> Comp- Grab. <br /> t1-0 L 0 <br /> 14 0 <br /> quis a ture) Received by: (St-9-n—ak-u-m-) Dat0frim <br /> A T, 2-C <br /> R411Kquis'hed by: (signature) Received by: (Signature) Dat*/T <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Slouht u re) Dat*fT!me <br /> 71-- <br /> Dispatched by: (Signature) Date/Time Received 17 <br /> D @[Time <br /> Method of Shipment: Laboratory Name <br /> Ch . I L <br /> Special Instructions: I hereby authorize the performance of the above indicated work. <br /> AIG-? eTi <br /> L <br />