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i <br /> CHAT OF CUSTODY RECORD <br /> Advanced Date 1 Wd(e Page -2- of- z— <br /> --- GeoEnvironmental, Inc. j� <br /> 837 Shaw Road-Stockton,Caldomia-95215-(209)467-1006-Fax(209)467-1118 �� <br /> M Pr Manager Tag Required <br /> Client <br /> P e N ber <br /> Z0 (0-7- (6 <br /> Invoice <br /> Samplers ( natur <br /> AGI` tZ <br /> ^ Client E3P;Number <br /> )ect Name <br /> Sample Type No of n' Nates <br /> Sample Location Date Time Water Air Solid Corns <br /> Description Comp Grab <br /> a[oSU� <br /> 1� U1� atzc� INC <br /> I <br /> --------- <br /> Outelri <br /> e ws e y rgn r calve y isnakure <br /> DatelTrme <br /> Rah shed by Received by (Signature) <br /> Daterrime <br /> Rehngwahed by ( ignature) iieeervad by Mobile Laboratory for field analysra (Sigrtatura) <br /> �T i Race-Wed for Laboratory by Oate/Ti <br /> llato/Time II\J A <br /> Dispatched by (Signature) <br /> Labor ry No <br /> Method o1 Shipment1111, � <br /> U i hereby au o a th ertormance at the above indicated worts <br /> Special lnstructwns `) �— <br />