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( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Data 7-1'7-02--- Page 3 oto <br /> 837 Shaw Road- Stockton, California- 95215- (209) 467-1006 - Fax(209) 467-1118 <br /> Client Pau Skiu Project Manager <br /> lb,1\ L.W�2 Tests Required <br /> Phone Number <br /> Zo"t - 9u 100(9 <br /> Sample (Signature) y Invoice <br /> w <br /> 1 ( 0� AG E <br /> Project Name Wc4e-r(too 700A + Poe_ 1 �� Q Client ❑ <br /> Sample l Location <br /> Data Time Water Saq(oa Type Solid No at �4� h� � /V Notes <br /> Number Description comp Grab AirCants .� <br /> NW-7c/o f/80 �'1 P� 1.5 3� l 3 <br /> 1W'Jc, 0I170 Z. <br /> tW810/091704 9-17-oz 75t, <br /> e rnr5 a �gnature Receivedy rgnature atefrrme <br /> UV <br /> Relrn unshed by-(SighatbqeV Received by (Signature} ate1T1me <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Received for Laboratory by c� Date(Trrle <br /> Method of Shipment o Laboratory Name�. Cc. / Te-ck <br /> Special Instructions I hereby authorize the performance of the above indicated work <br />