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CHAIN F <br /> Advanced O CUSTOD r RECORD <br /> GeoEnvironmental, ane Date Z Page 2, of Z <br /> 837 Shaw Road - Stockton California 95215 - (209) 467-1006 - Fax (209)467-1118 <br /> Client A. I Pr ct Manager <br /> DLI A— -- Tests Required <br /> P e kumber <br /> B <br /> Sam p ers ( ature) Invoice <br /> Project Name AGE ' <br /> r Client ❑ <br /> Sample Location Sample Type , <br /> Number No of <br /> Description Date Time Water Air Solid Conts l Notes <br /> Comp Grab <br /> —r••C^ PREMVAT ON UNGTIRTM <br /> iMMAORUMNATED <br /> APMPRIA IN—,PRURVE IN IAB <br /> Y <br /> e inZuisey ( rgnatr eceive y ignature "DalefTime <br /> Relinby (Signature) Received by (Signature) <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatch ed b (Sr <br /> P Y 9 nature) Date/Time Received for Laboratory by Date/Trme <br /> Method of Shiprnent Laborat ry Nam �1 <br /> r <br /> —.-. -a I a UY" <br /> F <br /> Special Instructions I hereby auth rze the rfo mance of the above indicated work <br /> r C_ r_ - <br /> 1 <br />