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CHAIN OF CUSTODY RECORD <br /> Advanced <br /> � Date 4� —:7- Page 3 _ of $ " <br /> _ GeoEnvironmental, Inc. <br /> 837 Shaw Road- Stockton, California - 95215 - (209)467-1006- Fax (209) 467-1118 <br /> Client Project Manager ,. Tests Required <br /> A144 a, <br /> Phone N mber <br /> ��I- <br /> Samplers: (Signature) bf2-r— Invoice: <br /> L <br /> " � AGE <br /> Project Name client <br /> Sample Type 7 <br /> Sample Location Date Time Water Solid No. of / // Notes <br /> Number Description Comp. Grab. Air conts. 'v <br /> GiD-fs 13s� X X x <br /> l�i� _2v iNoS X X <br /> x;1 . 15 <br /> 11-410- <br /> 145 ' <br /> u121H5 ' <br /> y: ^azure Dalaffl a <br /> el Ise y: ign e) acewe tg <br /> }t—I&' /b00 <br /> "t Date/Timo <br /> Relinquished by: (Signature) Received by: (Signature) r <br /> Received b MoDila Laboratory for tleld analysis:(Signature) DatalTime <br /> Relinquished by: (Signature) Y <br /> DatelTima Hacefva0 for Laboratory by: DablTima <br /> Diapatched by: (Signature) _ _ <br /> �) •` � <br /> Malhod of Shipment: Laboratory Name <br /> t1 <br /> - I hereby authorize the performance <br /> /�-o-f->the above indicated work. <br /> Special Instructions l'+'Ii'-9�• LL•`---_ <br />