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( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. of <br /> Date ; l/ 63 Page OZ- ' r~ <br /> 837 Shaw Road Stockton, California-95215-(209)467-1006 - Fax(209)467-1118 <br /> Client d e,,l ? 11 Prosect Manager] <br /> Q Al a IL Tests Required <br /> Phone Number <br /> Samplers (Signature) Irwotce <br /> Project Name cy AGE � <br /> we <br /> n/ �e�S . t't��. Client ❑ <br /> Sample Location Sample Type No of <br /> Number Description Date Tlme Water Air Solid Corns �� � Notes <br /> Comp Grab <br /> ;u U2 kt ie-t M-t11 1 &////03 . 3 /- / J / J I <br /> ..e3 <br /> IkL; 04.".-a3 [ bCC zL / / ly <br /> e uis <br /> had b Received y (Signature) ate/Time. <br /> /1 L eO <br /> Relinquished by (Signature) Received by (Signature) Date rime <br /> Relinquished by (Signalure) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Dwo/Time Received for Labor at byDatern e <br /> 3D <br /> Method of Shipment a <br /> Special Instructions I hereb uthorixe the performance of the ab Gated work <br />