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Advanced CHAIN OF CUSTODY ECORD <br /> r rd <br /> GeoEnvironmental, Inc. Date � Z� Page of—,- <br /> 837 Shaw Road-Stockton,California-95215-(209)467-1006-Fax(249)467-1118 <br /> Client � (L Proj Manager <br /> �.� Tests Required <br /> Phone Numigpir <br /> AZ-JVC <br /> Samplers; Signatu (� Invoice: <br /> Project Name Pp. rrf �o /�L a AG „. <br /> ` Client �- <br /> Type le Typ <br /> Sample Location ampNo. of <br /> Date Time WatSolld <br /> Number Description er Comp. arab. Air Conts. Notes,/�. <br /> I A <br /> P tis• P�� � . rz� r �� <br /> - ( usr-z T r `b <br /> 10 <br /> toisr <br /> e mqu a e n a ece ve y: gna urs �.. atelTime <br /> Relinqu shed y: (Signature) Received by: (Signature) 't]ata/Tkma <br /> Relinquished by: 41gnature Received by Mobile laboratory for field analysis:(Signature) 66 <br /> 1'C r fJ f)atelTEme <br /> Dispatched by: (Signature) DetelTlms Received. ora oratory by: �, <br /> pOatelTlkre <br /> il. <br /> Method of,Shipment: n . d r Laboratory/lame <br /> Special Instructions: -. i hereby authorize the parldrinanc#Af <br /> the above indicatfi work. <br />