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( Advanced <br /> GeoEn�ironmental, Inc. <br /> CHAIN OF CUSTODY CORD <br /> - Date (a-RE` /Page l of <br /> nJ'Nnr7henr Culifnrnirr <br /> 1803 West March Lane, Suite A-Stockton, California-95207-(209)9560264- Fax(209)956-0700 <br /> Client5S Project Manager Tests Required <br /> 19i! kl <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> r AG E [✓]� <br /> Project Name 14 41 � I / �4j Client ❑ <br /> Sample Location Sample Type No. of <br /> Number Description Date Time Water Air Solid Conts. Notes <br /> Comp. Grab. <br /> Z_ (e- —r56 �z�s <br /> —3 <br /> RA,JL4 he <br /> Nle �{a � S-9 05 <br /> e iPqu s e y; ignat re Received y: ignalure) Date(Time <br /> Relinquished 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 Receivr for Laboratory by: r �! ale(Time <br /> Method of Shipment: Laboratory Name <br /> Special instructions: /y I hereby authorize the performance of the above indicated work. <br />