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---- -- <br /> Advanced CHAIN OF CUSTODY RECORD <br /> --- GeoEnvironmental, Inc. Date Page _ Of <br /> 837 Shaw Road- Stockton, California,-95215 - (209) 467-1006- Fax(209)467-1118 <br /> Client Project n er <br /> Test Required <br /> Phone Number <br /> s: (Si ature) Invoice: <br /> Project Name AGE <br /> Client ❑ <br /> Sample Location Sample Type <br /> Date Time Solid Na, of <br /> Number Description Water Air Conts. � Notes <br /> comp. Grab. <br /> .yam 3 16524 <br /> 13y 3 66525 - <br /> >fp <br /> . 66526 <br /> G000 CO PRESERVATION <br /> e inqui y: ignature Received by: ignature DatelTime <br /> Relinquished b : (Signature) VReceived by. (Signature) Date/Tlme <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) DaterTime <br /> Dispatched by: (signature) Dateffime Receiv r Laboratory b atelTime <br /> Method of Shipment: Laborator Na <br /> Special Instructions: I hereby auth Ize 1 e pert ante 1 the above indicated work. <br /> 1 <br /> r <br /> av'`V <br />