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CHAIN OF CUSTODY RECORD <br /> Advanced Die z7 l page / of ` <br /> GeoEnvironmental, Inc. ,Jc.ff- <br /> m <br /> 037 Shavr Road- Stockton.California -95215-(209) 467-1006 -Fax(209)467-111a <br /> Client h Projec i Manager �b � � Tests Required N <br /> m <br /> Phone NumbertI- <br /> to 6 N <br /> Samplers: (Signature) uy' Invoice: <br /> � <br /> AGE E3Project Name 1 i � //% �✓ c La Client <br /> m <br /> k0 ,� 3 <br /> 2/02 <br /> Location Sample Type Sid <br /> Date Time WateNo. of �� Q Q Notes <br /> Description comp. arab. Air Conts. <br /> z79 7 of 1> <br /> m <br /> oture eceare y: ignature D o Ime <br /> AW)ature)' Received by: (Signature) / ( 'Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory tot field analysis: (SlgnLre) DataJTime - <br /> Dispatched by:(Signature) DetaRime Received for Laboratory by: Datefnime <br /> Laboratory Hems D <br /> Method of Shipment: <br /> m <br /> (±petal Instrucbons: I hereby a ize 1 Dar ante of the aDova Indicated work. <br /> �� r <br />