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Advanced CHAIN OF CUSTODY RECORD <br /> _10 wq <br /> GeoEnvironmental, Inc. Date Page of <br /> 4005 North Wilson Way-Stockton,Cali fomia-95265-(209)467-1006-Fax(209)467-1118 <br /> )39 <br /> Client <br /> Project Manager Tests Required <br /> Phone,Number <br /> (;.oV ) g67- 1006 <br /> Samplers: (Signature r.N- Invoice: <br /> yd?it,c� � <br /> Project Name vs�.el� AGE <br /> ❑ <br /> Sample Location <br /> Sample Type O <br /> No. of ' <br /> Number Description Date Time Water Air Solid Conts. � Notes <br /> Comp. Grab. <br /> �1~114 W07 <br /> 1040 <br /> 10 X �( <br /> e nquis a y: ( ogn tur eceive y: (Signature) <br /> Dal (Time <br /> 1�tr-Yq�lS;3c7 <br /> .Relinquished by: (Signature) Received by: (Signature) DalefTime <br /> Relinquished by: (Signature) Received by Mobile laboratory for field analysis: (Signature) DalafTime <br /> Dispatched by: (Signature) Dale/Time Received for Lab ratory by. a1 DatalTime <br /> A. <br /> Method of Shipment l C Laboratory Name <br /> L fulc4rct <br /> o U�rh( � T� V0� <br /> Special instructions: "�— JF�14r�iT�UN 1 hereby authorize the performance of the above indicated work. <br /> GOOD CO��Cd i 10N 7r91 T <br /> MU SFACL ANT GON 44A4 <br /> �AINERe <br /> UC' tz <br />