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AdvanceCHAIN <br /> f ed OF CUSTOD RECORD <br /> GeoEnvironmental, Inc. Date 12096—C4 Page -2- of 12 <br /> 837 Shaw Road - Stockton, California- 95215 - (209)467-1006 - Fax (209)487-1118 <br /> Client t� Project Manager <br /> . Tests Required <br /> hone N tuber <br /> Sa rs (Signature <br /> Y Invoice <br /> Project Name AGE <br /> Client <br /> Sample Location Sample Type No of <br /> Number Description Date Time Water Ali Solid Conts Notes <br /> Comp Grab <br /> tot. <br /> aui(0 <br /> 117 <br /> JW tow �c <br /> e in is e y ignatura) eceive y (signature) Date/Time <br /> 1 ALJM <br /> Relinquished by (Signal re) Received by (Signature) Date/Tlme <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Datetrime Received for Laboratory by <br /> _ Dale/Time <br /> Method of Shipment Laboratory Name <br /> Special Instructions 1 , <br /> t� 1 �^ I herab uthorize the pe ce of the abo s indicated work <br />