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Advanced CHAIN OF CUSTOD*ECORD <br /> j <br /> GeoEnvironmental, Inc. Date Page _-3- -q-� <br /> 837 Shaw Road-Stockton,California-95215-(209)467-1006- Fax(209) 467-1118 <br /> Client Pr VM er Tests Requir .41 <br /> dt4 <br /> P ne Nu tier <br /> Samplers (Signature) Invoice <br /> AGE �E,' <br /> Protect Name � � � G Client ❑ <br /> Sample Type <br /> Sample Location date Time Water <br /> Solid No of -t' Notes <br /> Number Description Camp Grab Air Cants �q <br /> MkIl1 —t'!� <br /> w- /� 0X <br /> A1117-17'L m ij--17 !05 <br /> � C <br /> D telTimelinquie ey"42t e <br /> � 4 7a4D <br /> Relinquished by (Signature) Received by (Signature) Date/Time <br /> Rehnqurahed by SSignatum) Received by Mobile Laboratory for field analysis (Signature) � Date/Time <br /> Ar <br /> Dispatched by (Signature) Date/Time e1ve�(oLaboratory by Dote/Time <br /> � � 7� 3 � �' <br /> `1 .� <br /> Method of Shipment Laboratory Name4�eA <br /> Speciat Instructions `� }}-^ �� I hereby authorize the performance of the above Indicated work <br />