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( Advanced CHAIN CUSTODY RECORD <br /> _ GeoEnvironmental, Inc. Dated �- Pay 2- Of <br /> 837 Shaw Road- Stockton, California-95215- (209) 467-1086 - Fax (209)467-111 a os- - 141 <br /> Clients �� ����}�� Prated Manager Tests Required <br /> C c— <br /> Phone Number <br /> 4 <br /> Samplers (Signata,- <br /> invoice. <br /> Project Name Zr P&ITC-> V13. �D n Client Qe <br /> Sample Location Date Time Sample Type Soil No of Notes <br /> Number Description Water Air Conts <br /> Comp Grob <br /> a-25-- -� Ca' 2,S- 6z ,- s 7 <br /> ,rq 1b <br /> e U <br /> (5 fie <br /> y ionatur ace ve y rgnatura Dalarrime <br /> J <br /> slip uishe by (Signature) Received by (Signature) Data/Ti e <br /> Relinquished by (Signature) Received by Mobile Laboratory for Held analysis (Signature) DatelTime <br /> Dispatched by (Signature) Date/Time Received fora oratory ) Date(Tlme <br /> I .iA. a2- <br /> Method of Shipment boratory Name <br /> E <br /> Special Inslructlons <br /> I hereby authorize the performance of the above dlcaled work <br />