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R <br /> Advanced CHAIN OF CUSTODY RECORD <br /> --- GeoEnvironmental, Inc. Date 5� 3 Page of # <br /> 837 Shaw Road -Stockton,California- 95215-(209)467-1006- Fax (209)467-1118 <br /> Client ar o., et Project f"1 1 I rr Tests Required <br /> C��.ect Manager <br /> r <br /> Phone Number <br /> 0409- -7 <br /> Samplers: (Signature) Invoice: <br /> Project Name / AGE <br /> FW <br /> CGr AA t r (10 , � Client <br /> Sample Location Sam ype No. ofr <br /> Number Description Date Time, Water Air Solid Conts. Notes <br /> Comp, Grab. <br /> SNo ck Q,1 S-C.-v3 Ills 3 ; 1 Cofineos r i e <br /> STS' Z 1131 3. 1 Covtl OS,rJt <br /> STK <br /> IDS9- t pj°,Utwt9r 1i5� �( <br /> T40- E"T 13A71 f <br /> e used by—* (Signature) Received fiy�: (Signature) <br /> Oate/T%iG <br /> 30 <br /> mquished by: (Signature) Received by: (Signature) Dale rime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) DatelTime <br /> ceived for Laboratory by <br /> Dispatched by: (Signature) Date/Time ReDalelTime <br /> or 1Br ame � <br /> Method of Shipment: Lab4 Y <br /> Special Instructions: r 1 hereby authorize the performance of the above indicated work. <br />