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l Advanced CHAIN, OF CUSTODY RECORD <br /> - Date 7 6165 Page '-7- of_ <br /> GeoEnvironmental, Inc. <br /> 837 Shaw Road - Stockton, California -95215 - (209) 467-1006 - Fax (209) 467-1118 <br /> _ Client Project Manager <br /> - 3 Tests Requires! <br /> P one Number <br /> Samplers: (Signature) j / Invoice: <br /> Pr:ojoct Name ----� �._ ! i AGE . <br /> r Client ❑ <br /> Sample 0cat 0n Sample Type Na, of // / [gates <br /> Date Time Water Solid <br /> Number Description Comp. Grab. Air Conts, / <br /> e inquis y: Ig ture) ---Received y: (Sig natura Da e(Time <br /> -Z <br /> Relinquished by: (Si nature) Received by: (Signature) Detel7ime <br /> Relinquished by: (Signature) Received by Mobile Laboratory far field analysis: (Signature) Data/Time <br /> 'Dispatched by: (Signature) Dale/Time ReG 'v r Laboratory b �, qa ime(�� \ <br /> Method of Shipment' Laboratory Name 1Al�t�r + 4-T <br /> Special Instructions: VEZ_ '� �� I hereby authorize the perform nce of the above indicated work. <br /> a <br /> t <br />