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f Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date �`Oz/a� Pageof <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> Client \ <br /> `c <br /> Pro <br /> �E ject Manager <br /> CC / Tests Required <br /> Phone Number <br /> 4 � GYSGo <br /> Samplers: (Signature) , Invoice: <br /> Project Name AGE <br /> Client ❑ <br /> Sample Location Sample Type ' <br /> Number Description Date Time Water Air Solid C°rts Notes <br /> Comp. Grab, <br /> /O/� � � � � l 66698 <br /> VG &G MTAl. 0 EI3 <br /> ICEF ON <br /> GOOD CONDITION APPROPI LATE <br /> HEAD sP cF A°s I`IT c <br /> Re mqu a y: (Signature ecetve y: gnature <br /> Date/Time <br /> Relin ished by; (Signature Received by: (Signature) Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Date[Time <br /> Method of Shipment: Laboratory Name <br /> aV �G C' <br /> el <br /> Special instructions: <br /> I hereby aut rite the performance of the above Indicated work. <br /> 1 <br />