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Advanced �( CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date0??-L4S Page <br /> 4005 North Wilson Way-Stockton Califomta 95205 (209)467 1006-Fax(209)467-1118 <br /> ClientL4 C4 Lkoc�5 <br /> 4 Protect Manager Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> �la A L(, AGE �1 <br /> Protect Name Z �� s 'q Client ❑ <br /> j� <br /> Sample Location Sample Type Date me No of <br /> Time <br /> Number Description Comp Grab Water Air Solid Conts �� Notes <br /> I <br /> a 1�nhr, I a-�-�-oma 11:45 x } <br /> 1t�- err�- 10 00 <br /> =7-tom itis X <br /> n e y ( ignature) ve y ign re Dz <br /> Time <br /> _tow <br /> e q ed by (Signature) Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date(Time <br /> Asur <br /> Dispatched by (Signature) Date/Time Recewed for Laboratory by Date/Time <br /> JIM <br /> "- Met o of Shjpment Laboratory Name <br /> N A a)CA <br /> Specs truchons I hereby authorize the performance of the above indicated work <br /> K <br />