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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date '3/y/68' Page I of I <br /> 637 Shaw Road- Stockton, California-95215- (209)467-1006 - Fax (209) 467-1118 <br /> ' <br /> Client ,i Project Manager Tests Required <br /> r <br /> Phone Number iyf <br /> ( P Oq) q U 1- 1 Ock-p <br /> Samplers: (Signature) lrrmice: <br /> Project Name ' ` AGE <br /> s o Client ❑ <br /> Sample Location Sample ype No. of 5 <br /> Number Description Date Time Water Air Solid Corns ✓ Notes <br /> Comp. Grab. <br /> I I 2 Gk 09..2E X X X X X <br /> �cl/urne� Tank 'P�'♦• X I \, � " <br /> 0 21a Ga 0935 l� n <br /> e i urs s i n rh�e ecerve y:Wgn-at—u-r-OF Data rima <br /> Relinquishedignatu1) Received by: (Signature) m e <br /> S.T. A.T DatafTi <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) DatelTime <br /> Dispatched by: (Signature) Datelrime Received for Laboratory � Date/TI <br /> f I J. <br /> Method of Shipment: La story Name <br /> d ✓o C C a e <br /> Special Instructions: I hereby authorize the performance of the above Indicated work. <br />