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{ Advanced CHAIN OF CUSTODY RCUORD <br /> GeoEnvironmentai, Inc. Date uPage <br /> 637 Shaw Road-Stockton, California- 95215-(209)467-1006 - Fax (249)467-1118 <br /> Client Project Man" r <br /> 7 7— Tests Required <br /> done Number <br /> Ev <br /> lets (Si nature) (nvotce <br /> Protect Name �/ �1 AGE <br /> Client ❑ <br /> Sample Locat n Sample Type <br /> Number Description Date Time Water Air Solid of <br /> Con < Notes <br /> Comp (trail <br /> �v -� <br /> zb <br /> e in9u y Ignatur ece ve y gnature <br /> L}a !Time <br /> Relin uished y (Signature Received by (Signature) ` ' b <br /> D te/Time <br /> Relinquished by (Signature) fieceived by Mobile Laboratory for field analysis (Signature) <br /> 5g Dale/Time <br /> Dispatched by (Signature) Date/Time R aboratory by <br /> //ADaleffime <br /> Method of Shipment ' <br /> - Labo ary a <br /> .8 r <br /> Special Instructions <br /> I hereby aut ize the erf once of the above Indicated work <br /> r� <br />