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( Advanced CHAI F CUSTOD RECORD <br /> GeoEnvironmental, Inc. Date j Page t or <br /> 037 Shaw Road- Stockton, California-95215-(209)467-1006 - Fax (209)467-111a <br /> Client �� �I �- Project Manager Tests Reered <br /> P one Nu ber �L <br /> w po 6 <br /> Samplers (SignatureInvoice <br /> Project Name { T AGE Dir, <br /> Client ❑ <br /> Sample Location Sample Type No of <br /> Die Time <br /> Number Description Water Air Solid Conts ti Notes <br /> Comp Grab <br /> q11 <br /> kv 115q Kl <br /> w� <br /> 1w 1 X X <br /> 1227 <br /> , AW 2S6 <br /> RelInquisheign ureReceived y (Signature) ate m <br /> l li6 3e) <br /> Relinquished by (Signature) Received by (Signature) Dat !Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) � Datefrime <br /> Dispatched by (Signature) DatelTrme Received for Laboratory b 1 Datefrime <br /> Method of Shipment CGk ( La ra ory Name <br /> Special Instructions + I hereby authorize the performance of the above end cated work <br /> I � <br />