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CHAIN OF CUSTODY RECORD <br /> Advanced <br /> -- GeoEnvir®nmental, Inc. pace �i U�� _ Page ­7 m <br /> --- :; <br /> 837 Shaw Road - Stockton, California - 95215 - (209) 467-1006 - f=ax (209) 467-1118 <br /> Project Manager <br /> Tests Required <br /> Client i4 <br /> Phone Number <br /> Samplers: (Signature) ) Invoice: <br /> r AGE F] <br /> Project Name "_ Client ❑ <br /> Sample Location- Sample Type No. of k r Notes <br /> Number Description Date Time Water Air solid No. <br /> Comp. Grab- <br /> lt;I` -s- 161 7crinr4 Mud , 6rhS V:'-)it,, ' ` u °'x ., <br /> r .A `B 1 L vi.o61 11 w <br /> }a `x, <br /> X[Xr-i h'.l '' u )� _s r ( ` �3 <br /> Date rime <br /> Relinquished y: (Signature) _P Rbeeived by: (Signature) <br /> Oate(Time <br /> Relinquished by: (Signature) Received by: (Signature) ' 1(S e' <br /> S f <br /> Relinquised by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date rime <br /> h <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: DatetTime <br /> Laboratory Name <br /> Method of Shipment: <br /> Special Instructions: f hereby authorize the performance of tha above indicated work. <br />