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j Advanced CHAIN OF CUSTODY RECORD <br /> Date A""3-5 Page of Z <br /> GeoEnv�ronmental, Inc, n <br /> 837 Shaw Road- Stockton, California-95215-(209)467-1006-Fax (209)467-111a 06 - +409 <br /> Client C-126rlt:�s Prot at Manager <br /> � Tests Required <br /> �� r CLcl <br /> Phone Number <br /> Y67 -/2)6 6 <br /> Samplers (Signature) Invoice. <br /> b <br /> Prosect Name AGE <br /> 6'zzc'� <br /> _��iJ�,a�✓ � Client ❑ <br /> Sample Type <br /> Sample Location No of <br /> Number Description Date Time Water Air Solid Conts Notes <br /> Comp Grab <br /> 1/w' aC:.c1C' IA &�c��� 41jL 3 <br /> V VW56 14so <br /> wackc-eusVLd �� 1337 7` <br /> e nq �e ygnat a ece ve y ignature DatelTim r <br /> fIG r <br /> Relinquished by (Signarur Received by (Signature) Data[Time <br /> Relinquished by (signature) Received by Mobile Laboratory for field analysis (Signature) Datefrime <br /> Dispatched by (Signature) Date/Time Aecawed for Laboratory by DatolTime <br /> Method of Shipment Laboratory Nem <br /> Special Instructions I hereb auth ize t e p forma a of the above Indicated work 1 <br />