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Advanced CHAIN OF CUSTODY RECORD <br /> - GeoEnvzronmental, Inc. Date 7-1 i -00 page C)- of� <br /> 4005 North Wilson Way-Stockton,California 95205-(209)467-1006-Fax(209)467-1118 <br /> ClientProject Mana er <br /> �n�'.� Ll.�, d � ✓� �� ��� � Tests Required <br /> Phone Number O <br /> o <br /> Samplers (Signature) Invoice, <br /> Project Name _ AGE <br /> Client ❑ <br /> Sample Location Sample Type , <br /> Date Time Water Solid No of Notes <br /> Number Description Comp Grab Air Conts <br /> '4cv l <br /> 4zsss <br /> Re nquis e yign a eceived y { ignature S TD TA ti Date/Time <br /> ARelinquished b ignature) Received by (Signature) Date/Time <br /> 1/ 9Cinor� _— Ir (tii <br /> l ltnquished by natu c d Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> d4atE. Jet <br /> O,?'pVche,1 bya i(Sig eL,4 Date[time R19Cgived for Laboratory b Date/Time <br /> Method of Shipment ) Labors ry Na e <br /> Ch <br /> Special instructions I I hereby authorize the performance of the above indicated work <br /> V— <br /> V <br /> Oil 'eC-el vecII�, � t V t� <br />