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f Advanced CHAIN OF CUSTODY RECORD <br /> Date &Vi = i Page 3 of <br /> GeoEnvironrnental, Inc. <br /> 837 Shaw Road-Stockton.Cali iornia-95215-(209)467-1006-Fax t209)467-1118 <br /> P7//1' ct Manager Client {�,�,(� P � � jig��� Test'3�Required <br /> .� <br /> Phone Number / <br /> �v,a, r <br /> Sampters.: (Signature) �{�` Invoice: <br /> Project Name # -�}�I — � ,�� AGE ,fl <br /> i1 ��tri'' f`va( � �C.� 2r.¢,« ' - ' <br /> Client <br /> Sample LocSample Type f <br /> Qate Time Water Solid No.of Notes <br /> Number Description comp. Grab. Air Conts. <br /> &-2-7-Z <br /> �- �ZS5Tx' <br /> e inglui ed =: (Signature) DateCrirne <br /> Relinquished by: (SignaW ea Received by: (Signature) Datefrinte <br /> Relinquished by: (Signature} Received by Mobile Laboratory for field analysis{Signature} Gatefrime <br /> Dispatched by:(Signature) Datefrime Received for Laboratory by: 3atefrime <br /> Method of Shipment: Laborat � Ni}me / I_4 ' <br /> (/ f <br /> Special Instructions: I hereby authorize the performance of the above indicated work. <br /> f` r^ <br />