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( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmenta�, Inc Date "w Page --3--at z- <br /> 4005 North Wilson Way-Stockton,California-95205-(209)4671006-Fax(209)467-1118 <br /> Client - ] Project Manager <br /> L.tcr�e, G� Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> Protect Name AGE10 <br /> ❑ <br /> � <br /> Sample Location Date Time Sample Type Water Solid No of v Notes <br /> Number Description Comp Grab Air Conts <br /> 95 IV 3D41 <br /> -7- 6-6 00 030 <br /> e ingws a ignature eceive y (Signature) S r 4�p �f ac}�}-� Date rime <br /> Relin uished b Si nature m fes rt G Q )Ah I h 2- Date/Time <br /> q Y ( g Received by (Signature) � p '� <br /> I nc,(nr.S bf Yrs Ped Cc &I-A? <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) r�G Date/Time <br /> Dispatched by (Signature) DatelTime Received for Labofatory by Date me <br /> UAb&612L�� 16 4-001' 1vl <br /> Method of Shipment Laboratory Name <br /> C C,s 1 01 cG � <br /> Special Instructions I hereby authorize the perfor ance of the above indicated work <br /> AA <br /> � � � fid � i� � � � � � i• � � � � � � � <br />