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TV4CHAIN OF CUSTOD RECORD <br /> Advanced <br /> GeoEnyironmental Inc Date Page it/. of�_ <br /> 837 Shaw Road- Stockton, California 85215 - (208) 467 1006 - Fax (209)467-1118 <br />� Cllent Project Mana r <br /> Tests Required <br /> y r <br /> Pone Numbert,�r� <br /> 1767 7 1006 <br /> 5 lert, (Signature) h Invoice <br /> Project Name r ` L �/ �� , AGE 0'" <br /> x yr Client ❑ <br /> Sample J Location Sample Type No <br /> Number Description Date Time Water Air Solid Contst / ` s Notes <br /> Comp flrab <br /> t <br /> /3 Ski <br /> e1i Received by gnalure Dale/Time <br /> Flf,hqu3shd b Signatur Received by (Signature) Date/Time <br /> QA I <br /> 0 dl <br /> Relinquishe y ign ture) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> r <br /> Dispatched by (Signature) Dato/Time Race ved Lab r or Datef ime <br /> Method of Shipment Laboratory am <br /> Special Instructions I hereby authorize the p rformance of the above Indicated work <br /> 21 —jLe 0 0 <br /> a <br />