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( Advanced CHAIN O CUSTODY RECORD <br /> GeoEnvironmentai, Inc. Date Page --L of <br /> 937 Shaw Road-Stockton, California-95215- (209)467-1006- Fax j209)467-1118 <br /> Client Project Mana er � <br /> Tests Required <br /> P n umber <br /> I <br /> S ers Signature) Invoice <br /> Project Name � AGS <br /> Client p <br /> Sample Location Sample Type <br /> Date Time Water Solid t Nates <br /> Number Description Comp Gran I hrConts <br /> 41 lk*Al I <br /> � - <br /> 10 <br /> (27 <br /> Bet q is ( eceiye y TTIgnature D toJTime <br /> Relinquishe by (Signat re Received by (Signature) <br /> ate/Time <br /> lei <br /> Relinquished by (Signature) Received by Mobile laboratory for held analy a Sign r <br /> m Date/Time <br /> V <br /> Dispatched by (Signature) Date/TEme Ro a for L bor ory y D telTIme <br /> i 6V -3() <br /> Method of Shipment abor ry Nam <br /> r <br /> Special Instructions I hereby a t onze th erlormance of the above Indicated work <br />