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4 Advanced CHAIN OF CUSTODY RECORD <br /> --- GeoEnvironmental, Inc. Date_, ��` Page --/-- art—! <br /> 837 Shaw Road- Stockton, California - 95215- (249) 467 130b Fax (209) 467 1118 <br /> Clientprole <br /> Vianager <br /> \ � Tests Required <br /> Phone Number 1 <br /> Samplers (Signature) Invoice <br /> Project Name � � � ,� AGE r <br /> Glient � <br /> Sample Type <br /> Sample Location Date TimeSoltci No of <br /> Number Description Water <br /> Comp Grub Air Con#s Notes <br /> i <br /> I <br /> iJ 'yd' <br /> 1'17u1 <br /> �leltnqu y ( nature) Ifeceiv-e��y Z$ipnatur-a — — — pate �n,a <br /> Rely shed by0l nel re) ftecelved by (Signetknn) �+�\ palel7t�na <br /> Relinquished by (Signature) Received by Mabild Laboratory for field anaiybtb (Signuhkfu) ilalnlTlrna <br /> Dispatched by (Signature) Datalrime _ Recalved for 1 ahoratory by Daltl/1IICkd <br /> Method of Shipment I aLaralory flame <br /> r <br /> Tem <br /> Special instructions I tk�cQLy-a+.� ze the performance of the abov Indlcniad wokic <br />