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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date 4,2 0,7- Page Of <br /> 837 Shaw Road - Stockton, California-95215- (209) 467-1006 - Fax(209)467-1118 Olt 0 S ? <br /> Pro Ma J <br /> Client g Tests Required <br /> Sione tuber <br /> a , Z Slers (Si nature) Invoice <br /> Protect Name AGE <br /> Client ❑ <br /> f <br /> Sample location Sample Type Date Time No of _ <br /> Number Description Water Air Solid Conts Notes <br /> Comp Grab <br /> z c,z J VOL � ' 4+ I I c <br /> A- 44 1 <br /> E,to A ye,f'- 2—"" <br /> I ' <br /> Relinquished y ( ignature) ececve y ignature atefTime <br /> c=z <br /> /ben) <br /> Relinquished by (Signature) deceived by (Signature) palefrime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Received for Laboratory bDate/Time <br /> Method of Shipment Lab amt ry Name <br /> Special Instructions I hereby authorize the performance of the above Indicated work <br />