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( Advanced r CHAIN OF CUSTODY RECORD <br /> –2) Page of <br /> GeoEnv><ronmental, Inc. Date <br /> 837 Shaw Road- Stockton, California 95215- (209)467 1006 Fax (209)467 1118 <br /> Client Lfr�� A ProtL a er Tests Required <br /> — iZt c kw4t LC- L6-,,, Phone Number <br /> Samplers (Signature) \` Invoice <br /> Project Name <- ! AGI` <br /> �i�t�►f 'tr M� f�_ r'l r ��1 �' �tr �`t Client <br /> Sample Location z Sample Type <br /> Number Description <br /> Date Time WaterAir Solid No of Cants / Notes <br /> �r Comp Grab <br /> htwat <br /> e inquishad h { ignature ece ve y ignature <br /> t7atelrime <br /> b <br /> Resin uished St <br /> q Y ( 9 nature <br /> I Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysts (Signature) Date/Time <br /> 1 <br /> Dispatched by (Signature) Dateffline R cel d} l aboratory by DatetTime <br /> Method of Shipment Laboratory ame <br /> 0 ]/L52—Zb�---C j\4 ( (d t. � ! <br /> Special Instructions GOOD CONDITION--:L— APPROPRIAM I hereby authorize tirfe performance of the above indicated work <br /> MEAD SPACE AASbNT CONTAINERS—msp IN FA <br /> {� <br /> REC90 StALW & INTACTIVIVi VQA13 Oka I MSTAIA I OMERf,'��0 <br /> + I <br /> PRE9FRVATT0N ""'tel. <br />