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j Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date �'l "�� Page 3 of 3 <br /> � Z ol ` <br /> 837 Shaw Road- Stockton, California-96216-(209)467-1006- Fax (209)467-1118 S <br /> Client Pro'ect Ma or <br /> nag, <br /> Tests Required <br /> Phone Num gr <br /> Samplers: (Signature) ' Invoice: <br /> Project Name IR <br /> r"T� r5-, � ,, AGE <br /> � Client <br /> Sample Location <br /> Sample Type No. ofNotes <br /> Date Time Water Solid �Y <br /> Number Description camp. crab. Air Conts. <br /> u,T�-ooS t t57�2 W ►( Z7 az 6=�� K <br /> -TTW <br /> e y: netecmve y: rgnature Dats(Time <br /> f � OL (2�uJ <br /> Reli quished by: (Signature) Received by: (Signature) / . Dateyrime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: ./ Date/Time <br /> Method of Shipment: LaboratoName <br /> '0;eo" <br /> Special Instructions. I hereby suthorize�formanc o he a ve Indicated work. <br />