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j Advanced CHAIN PFi CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date Page --L otI <br /> 837 Shaw Road - Stockton, California-95215- (209)467-1006 - Fax (209)467-1118 <br /> Client Project Manager <br /> �&'t- Tests Required <br /> P ne biumber <br /> Sam lers (Signature) Invoice. <br /> Protect Name �'! AGE <br /> t'iI!rJ'!•- Client ❑ <br /> Sample Locati n Sample Type <br /> Number Description <br /> Date Time Water Air Solid No Notes <br /> q Comp Grab <br /> n <br /> { o`� <br /> F)ZkQ COT <br /> e in u e i store) ecei ygnatDate/Time <br /> ure <br /> Q� f1k o 2—3, -W I <br /> Relinquished by (Stgnaturlbf Received by (Signa re atefTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date[Time Received for Laboratory by <br /> Datel'rime <br /> Method of Shipment Labor fry Name <br /> Special Instructions n <br /> D reby 1 heorae the pert mance of the above Indicated work <br /> `� <br />