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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmenta , Inc. <br /> Date �' �� Rage of -3 <br /> 637 Shaw Road-Stockton,California-95215-(209)467-9006-Fax'(209)467-1118 <br /> �' Project Manager <br /> Client ���� � , " #+� Tesmaequired <br /> Phone Number <br /> v <br /> Samplers: (Signature) Invoice: <br /> Project Name f!�� �� ` / , � AGE [v� <br /> Client . <br /> f <br /> Sample Location pie Time Water Sample Type Solid No.of �� �' Dotes <br /> Number Description Ajr Coats. <br /> Comp. Grab_ <br /> 2. <br /> - 4 <br /> r <br /> e inquished (Signature)a_ Received by= (Signature) t Datelrime <br /> Relinquished by, (Signature) Received by: (Signature) Datelrime <br /> Relinquished by-(Signature) Received by Mobile Laboratory for field analysis:(Signature) DateiTime <br /> Datemme Received for Laboratory by: Datejrime <br /> Dispatched by:(Signature) ? / /r <br /> Method of Shipment: Laboratory Name L <br /> A--L- —76�: Lel <br /> Special Instructions: thereby authorize the performance of the above indicated worts. <br />