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( Advanced l Z —0 Co CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date Page of <br /> 837 Shaw Road- Stockton, California- 95215- (209)467-1006- Fax (209)467-1118 <br /> Client �� Project Manager Tests Required <br /> lij <br /> f�7jyljtf7 ( '�� r,{ y(� r Phone Number <br /> Samp ers: (Signature) +, Invoice: <br /> Project Name � � })' AGE <br /> Pe S S C>eljS ._G per- Client ❑ <br /> (/ <br /> Sample Location Sample Type Date Time WSofid No. of <br /> Water Notes <br /> Number Description Air Conts. ' <br /> Comp, Grab. <br /> CPT-3 � � - ���t rr -Z�- . Z35 ✓ <br /> e inqu s e y: i9n tura Received y: gnaturo Dalof lme <br /> HT1r <br /> Relinquished by: ( ign re) Received by: (Signature) rJr t Date/Time <br /> Relinquished by: (Signature) Received by Mobile laboratory for field analysis:(Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Received for AhbArnjory by• Date/Time <br /> Method of Shipment: laboratory Name <br /> C'/,.1 Teti c <br /> Special Instructions: I hereby authorize the performance of the above Indicated work. <br />