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( Advanced CHAI F CUSTODY RECORD <br /> _-- GeoEnvironmenta , Inc. Date �� ° Page Of <br /> 837 Shaw Road - Stockton California- 95215- (209)467 1006- Fax (209)467-1116 O� <br /> ClientProject Manager <br /> � Tests Required <br /> one Number <br /> Samplers (Signature) Invoice <br /> k <br /> Project NameAGE� <br /> � � f ) Client ❑ <br /> Sample Location Sample Type No of <br /> Number Description Date Time Water Air Solid Corns Notes <br /> Comp Grab <br /> uw� <br /> nog XX <br /> WA;�r-l( Lk,�SL 16 t7 I? <br /> i ui e _ y_ ignat ecerve y ignature) ate <br /> Relinquished by (Signature Received by (Signature) DatetIime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date(Frme <br /> Dispatched by (Signature) DatelTrme Received for Laboratory by� DatelTrme <br /> Method of Shipment Labo e <br /> Special Instructions I hereb au Drize the eriormarl a of the above Indicated work <br /> car' <br />