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( Advanced CHAIN 9FCUSTODY RECORD. <br /> GeoEnvironmental, Inc. Date Page <br /> 4005 North Wilson Way-Stockton,California-95245-(209)467-1006-Fax 9)481118 <br /> Client Pro'ect Manager <br /> Tests Requir d <br /> Pe N r� <br /> pie : (Si ature) Invoice: <br /> Project Name AGE.P� <br /> Client ❑ <br /> Sample Location Sample Type No. of � b <br /> Number Description <br /> Date Time Water Solid Notes <br /> Comp. Grab. Air Cants. <br /> I I <br /> -X I x <br /> 44908 r <br /> s <br /> T— <br /> Relilquioad bIff Ig atu Received by: (Signalure) Date/Time <br /> �- <br /> Reli quashed by: (S nat re) ` Received by: ( ignature) 6ate(Tlme <br /> Relinquished b (Signature)9 Y� ( 9 ) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: DateTime <br /> Method of Shipment: Laboratory Name <br /> Special instructions: / _ I hereby au h ize the pe forma a of the above Indicated work. <br />