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i • • <br /> j Advanced <br /> i)D(E� <br /> CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental Inc. oat$ -+_64 Page ' of�-- <br /> 837 Shaw Road-Stockton, California- 95215- (209)467-1006- Fax (209)467-1118 <br /> Client Pr Manager <br /> Tests Required <br /> Phone Nu ber <br /> /10 <br /> Samplers (Signature) Invoice <br /> Project Name �� AGE <br /> �,�� q� � SRA�\ � Client ❑ <br /> Sample Location Sample Type <br /> Date Time Water Solid No of Notes <br /> Number Description Comp Grab Air Conts <br /> quished y (Signature RiCeiVeG Dy ignature Date/Time <br /> VAKncfuished by (Signature) Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysts (Signature) DatelTtme <br /> Dispatched by (Signature) Date/Time Received for Laboratory l Date/Tir <br /> Method of Shipment � L orata Na <br /> Special Instructions I hereby authorize the performance of the above Indicated work <br />