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Z <br />r; - <br />j Advanced <br />GeoEnvironmental, Inc. <br />837 Shaw Road - Stockton, California - 95215 - (209) 467-1006 - Fax (209) 467-1118 <br />CHAIN OF CUSTODY RECORD <br />Date Page of 3: <br />06-a Z 7 <br />ClientProject <br />Project Name <br />d3kC��� <br />Sample <br />Number <br />Ca rc <br />Location <br />Description <br />Date Time <br />Manager <br />N\\ L "t\, ` Tests Required <br />Pion Number <br />Q°1 - Lilo'- 10 W. <br />Samplers: (Signature) Invoice: <br />AGE ❑ <br />49Client <br />Sampl ype No. of -T �� <br />Water' Air 50lid Cortts. � Notes <br />Comp. Grab. <br />STK - 1 <br />G -4-o-1 <br />1304 <br />1 <br />1 k' <br />I -15 e byy/: (Signature) <br />,A <br />linquished by: (Signature) <br />eceive T ,gnature <br />Date/Time <br />u <br />� � { -a-1 / 1(✓ <br />Received by: (Signature) <br />Date/Time <br />Relinquished by: (Signature) <br />Received by Mobile Laboratory for field analysis: (Signature) <br />Date/Time <br />Dispatched by: (Signature) <br />Date/Time <br />Received for Laboratory by: <br />` <br />Date/Time <br />-J ") a� <br />Method of Shipment: t <br />CGa i <br />_ <br />(1tiJ?f � <br />Laboratory Name '(` <br />� I�+PC <br />Special Instructions: <br />I hereby authorize the performance <br />of the above indicated work. <br />