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Advanced CHAIN OF CUSTODY RECORD <br /> ( <br /> --- <br /> GeoEnvironmental, Inc. Date 5 '` q Page —j— of Z <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467.1118 <br /> Client Project Managed f t� <br /> KPI,t, M c1,� <br /> Tests Required <br /> Phone Number <br /> f6`I - lA67 - 1006 <br /> Samplers: (Signature) rU Invoice: <br /> Project Name M q 1 -t CC( C i yc!>r if �lt> � �t 1�tr� s1 N ` ~�� AGE E] <br /> y � �. C.lent ❑ <br /> Sample Type <br /> Sample Location No. of �Z` o� <br /> Number Description Date Time Water Air Solid Conts. � Notes <br /> ! L y Comp. Grab, <br /> 5 4 7)D(h'i 1� NOr l i} w 'Y�f 1 1 rO <br /> 16748 <br /> 5 P 3 i1 :. lu K 1 <br /> - - — . 16749 <br /> L t � <br /> 5 P 5 5),tAol I— 5nul 1, W 16756. — <br /> 5P6 <br /> Y� 7 16751 <br /> ,e//+nquis a y: +gnature oce ved by: +gnarute G g9 onterllme <br /> Relinquished by: (Signature) 1leceived by: (Signature) 1' +*-" + 'A ''I` J date/Time <br /> Q}e4'j r FAx 7r' V.rVv I <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) ` , 3o or, FNi f a/ Date/Time <br /> KI y �� ,, Cl <br /> Dispatched by: (Signature) Oate/Time Received lot Laboratory by: Date/Time <br /> Method of Shipment: Laboratory Name <br /> C A D r, V1,2 11 IC P4 nn✓ r.,EftVApM VOAS I O&G METALS1 OTHER H ` CQ f,1 f, y-t 1( <br /> Special Instructions: GOOD CONDITION <br /> nta I hereby authorize the performance of the above Indicated work. <br /> b} UU�VIY I+il1 AUPROP tHS V_(111� <br /> l/ <br />