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M <br /> • • <br /> Advanced CHAIN OF CUSTOD*ECORD <br /> � <br /> GeoEnvironmental, Inc Date Page o `Z- <br /> 837 Shaw Road - Stockton, California-95215 - (209) 467-1006 - Fax (209)467-1118 <br /> i <br /> Client /, PrVect.manappir Tests Required <br /> Gc40, Ka <br /> P one mber <br /> Samplers (Signature) Invoice <br /> AGE <br /> Project Name kClient E]� <br /> Sample Location No of Notes <br /> Number Description Date Time Sample Type Water Air <br /> Solid Conts <br /> Comp Grab <br /> 6 C <br /> W -2- <br /> 43-3 �,� - 1°( <br /> _l� �1W- z4' r\ <br /> ehnquts e y ( n re} eceive y ignalure Da tm <br /> 1Te <br /> Relinquished by (Signa re) Received by (Signature) Date/Time <br /> Relinquished by (Signature} Received by Mobile laboratory for Held analysts (Signature) 3TAT Datefrime <br /> Dispatched by (Signature) Dateftime Received for Laboratory by Date rime <br /> 6? <br /> Laborato a e <br /> Method of Shipment C4 <br /> (\ r 1 hereby authorize the performance of the above indicated work <br /> Special Instructions <br />