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• i <br /> [ Advanced CHAIN PF)CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date Page —L of <br /> 837 Shaw Road- Stockton, California-95215- (209)467-1006- Fax (209) 467-1118 Client-PrClient- <br /> Prr Ma a <br /> inier <br /> 10 <br /> 17, Tests Required <br /> Pyne Number <br /> Sam ers (Signature) Invoice, <br /> Protect Name AGE <br /> � Client ❑ <br /> Sample Location Sample Type <br /> Number Description Date Time Water Air Solid <br /> Comp Con Of <br /> r <br /> Notes <br /> Grab <br /> 12/5 <br /> ioZ 132 <br /> 035 Xr <br /> r r�� <br /> d Q"t <br /> !to(0 <br /> 1f <br /> e ingms a nature) eceive y ignature <br /> WefTima(Time <br /> Rehnguished by ( ignature) Received by (Signature) <br /> o ` <br /> earn ►ns#►ed I�yr(Si wre) ri r+ u Race ed by Yot:ile Laboratory for field analysis (Signature) <br /> ralt( ' .'sE4y ;' ` r 1,_ <br /> eh (t�yg lure Fie 1r� iiJ DateJTlma Received for La oratory by <br /> ` ate/Ti e <br /> Method of Shipment oryTt me <br /> Special Instructions <br /> 1 hereby a o :e the rf mance of the above Indicated work <br />