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i• i• !• i• ! ! i ! ! i i i i i tll� tom! ttttttttt� ttttttttti <br /> � � O <br /> ( Advanced CHMeo'XLC <br /> USTODY RECORD <br /> � Date Page � of <br /> GeoEnvironmental, Inc. n 1t,2 3 ',(& r W1 k ' c rsL <br /> 837 Shaw Road - Stockton, California-95215- (209)467-1006 - Fax (200 467-1118 <br /> Client Project Manag r <br /> Tests Required <br /> ,°. <br /> PPpne Number <br /> �aoi `QLY <br /> p ers (Signature) Invoice. <br /> Project Namer AGE <br /> re 45tVq,— Client ❑ <br /> Sample Location Sample Type No of <br /> Number Description Date Time Water Air Solid Conts Notes <br /> Comp Grab <br /> I � <br /> 90620 <br /> 90621 <br /> r-, TOM <br /> "i <br /> n� <br /> n <br /> i�"i Vi rIi �- <br /> e in is ed ign tur Recei ate/Time <br /> 7& <br /> Relin uishe b (Sig ature R i e (Sign ture) r, Daterrime <br /> 2 l8 D2I-h i� o <br /> Relinquished by S+gnat re) RNcesved by Mobile Laboratory for field analysis (Signature) p� Date/Time <br /> Dispatched by (Signature) Date/Time Received for Laboratory by DatelTlme <br /> Method of Shipment Laboratory me / <br /> Special Instructions I hereby authorize th erformance of the above indicated work <br />