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IF <br /> Advanced CHAIN OF CUSTODY RECORD <br /> _-- GeoEnvironmentai, Inc Date 6112,41 Page of <br /> 837 Shaw Road - Stockton, California- 95215 - (209) 467-1006 - Fax (209)467-1118 <br /> Client Prosect Mana erAu <br /> Tuts Required <br /> Phone Number <br /> Sa- kf1 <br /> S piers Signat re) <br /> �� �b Invoice <br /> Protect Name � �r� �� AGE , ' <br /> Client ❑ <br /> Sample Location Sample Type <br /> Date Time No of <br /> Number Description Water Solid Notes <br /> Comp Grab Air ContS <br /> L,o dX 742- <br /> tor SZ <br /> Re inq y tgnature) A ec—e—1v 5-9 6 y (Signature) 12,ZfTtm.e <br /> IT C <br /> (, <br /> Relinquis (Sign e) Received by (Signature) ate/Time <br /> Reitnquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Tirne <br /> Dispatched by (Signature) Date/Time Received for Laboratory by Dat /Time <br /> ,ea i 0 L �o <br /> Method of Shipment n c a. r Laboratory Name � l <br /> (�]�PK,I r /iWl rG�1t-lam F L M{ <br /> Special Instructions I hereby au)Jukriza the performance of the above indicated work <br />