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j Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date I -Z .T Page of <br /> 837 Shaw Road-Stockton, California-95215- (209)467.1006- Fax(209)467-1118 7 <br /> V r Zo I <br /> Client Project Manager <br /> iTests Required <br /> 4 i1 <br /> Phone Number <br /> Samplers: (Signature)/At z-- y Invoice: <br /> Project NameAGE t4 <br /> Q ,✓ P� / ��" {tr Client <br /> Sample Type <br /> 'Jam+ fy <br /> Sample Location Date Time Solid No. of �/ Notes <br /> Number Description Corlts. <br /> Comp.Water Air Grab. <br /> B`I-i5 q -2N-IVS-7,3 <br /> v X <br /> IS'�-2i7 X X?.5 ''''WI IroL.-D <br /> Relinquished y: ignatur aceive y: 19nature Dats/ti <br /> Zv-� ISfJA <br /> Relinquished by: (Signature) Received by: (Signature) 5• T-( Date ima <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Date/time Received for Laboratory by J DablTl <br /> Method of Shipment: Labarato Name <br /> C� <br /> Spacial Instructions: 1 hereby auutthho/�rriize the performance of the above Indicated work. <br /> 2 <br />