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J <br />j Advanced <br />GeoEnvironmental, Inc. <br />837 Shaw Road - Stockton, California - 95215 - (209) 467-1006 - Fax (269) 467-1118 <br />CHAIN OF CUSTODY RECORD'` <br />Date 10-4-03 Page Z of 3 <br />c0 � 0 2 7 <br />Client�� <br />-oject Manager <br />Tests Required <br />Rhone Number <br />'04 - <br />$amplers: (Signature) <br />Invoice: <br />� <br />Project Name <br />ACi►n��C'� <br />�' ��S <br />^� <br />.., <br />�` <br />AGE ❑ <br />Client <br />Sample Location <br />Sam Type <br />No. of <br />Number Description <br />Date Time <br />water' Solid <br />Air <br />Coats. <br />Notes <br />Comp. Grab. <br />1ZZo- <br />-1p <br />1141 <br />OSP- �3 <br />I z 34 <br />sTx--►4 <br />�zs5 <br />3 <br />3:1 Cot^eos, <br />Rol* s eignature <br />/460thIV3o <br />ecerve y: gnaiure <br />Datefrime <br />by :: (Signature) <br />Received by: (Signature) <br />Date/Time <br />Relinquished by: (Signature) <br />Received by Mobile Laboratory for field`ginalysis: (Signature) <br />Date/Time <br />Dispatched by: (Signature) <br />Date/Time <br />ived for Laboratory by:- <br />Date/Time <br />1 <br />C � <br />6 -t-Js JJ <br />Method of Shipment: <br />CG I ()aer <br />Laboratory Name <br />ca <br />Special Instructions: <br />NJ <br />I hereby authorize the performance of the above Indicated work. <br />