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! i � <br /> CHAIN OF CUSTODY RECORD <br /> t ? _ Advanced Date 1st��_ Page —�— of <br /> --- GeoEnvironmental, Inc. <br /> 837 Shaw Road-Stockton,California-95215-(209)467 1006-Fax(209)467-1118 0 — `I <br /> Required <br /> �- <br /> Client !v 1'SC Proje�i ill p`LC,0c,,� �wlT <br /> Nurqbe <br /> P )C)) 4u2-7- W O O invoice <br /> Sam ers (Signature) <br /> AGE <br /> Cheat ❑ <br /> Project Name (V,C',C', IS, <br /> Sample Type No of Notes <br /> Sample Location Date Time Water $°�'� Conts <br /> Pur <br /> Number Description comp arab <br /> t11" <br /> u�.� 1 3 <br /> ?A�3 <br /> 0t9 3 <br /> V t,� � DatalTimp� u'�V <br /> quis I ture ecerve y Ignature U�G Jt�'` f <br /> DatelTime <br /> Re nquished Iona are) Received by (Signature) <br /> Date/Time <br /> Relinquished by (Signature) Received by Mabite Laboratory for ll analysis (Signature) <br /> tlecerve I for Laboratory ? Date rime <br /> Datelrlme <br /> Dispalched by (Signature) i <br /> Lab ado ry Name <br /> tlethod of Shipment <br /> 1 R I hereby authn ze the p rlormance of the above Indicated work <br /> Special tastructions / ✓ �� <br /> I <br />