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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date— / Page _ of <br /> 2- <br /> - <br /> R24 837 Shaw Road - Stockton, California- 95215- (209) 467-1006- Fax (209) 467-1118 10 <br /> Client ✓ Project Manager Tests Required <br /> Phone Nutnber <br /> Cao9 7- 6b <br /> Samplers: (Signature) Invoice: <br /> __// <br /> ClientProject NamAGE Clientre <br /> Sample Type <br /> Sample Location Date Time Water Solid No. �C Notes <br /> Number Description Comp. Grab. Air Conts.s. <br /> -a-c\b <br /> kaJca /b� bL4 <br /> 1 35 I J <br /> 05 <br /> e ingws a y: ( ignatur ecerve y: rgnature t „� �_ /�- , r Dete/Time <br /> R quished by: (Signa ure Received by: (signature) TA� Dat (time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Date/Time <br /> _ 21 <br /> Method of Shipment: Laborsamen /rn <br /> raxG/ 1 <br /> Special Instructions: I hereby authorize the performance of the above Indicated work. <br />