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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc Date a a Page of 2 <br /> 837 Shaw Road Stockton California- 95215-(209)467-1006- Fax (209) 467-1118 <br /> ClientProject Manages <br /> � Tests Required <br /> , t <br /> P ne Number <br /> gol7-I00� <br /> Samplers (Signature) ,(� Invoice <br /> Project Name /i< <� Client ❑ � <br /> Sample Location Sample Type No of <br /> Number Description Date Time Water Air Solid Conts Notes <br /> Comp Grab <br /> X XXIX I 1-7� <br /> A,,LLJ z 1 1 1 t l - 2w <br /> VJ <br /> C)15 60 <br /> A,Q G b ~ tow <br /> , 37 ,,u,� "'l� <br /> e inquis e y ignat a) Received by ignature t) elTim <br /> -7/1�t 6 <br /> Relinquished by (Signature) Received by (Signature) Dateffilne <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) f� Date/Time <br /> Dispatched by (Signature) Date/Time served tar Laboratory by f� DatafTime <br /> an `10W <br /> Method of Shipment Laboratory NameC <br /> 44 le. <br /> Special Instructions `� c }_— I hereby authorize the performance of the above indicated work <br />