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j Advanced <br /> CHAIN OF CUSTODY RECORD <br /> " <br /> GeoEnviron mental, Inc. Date 2-4 Page Z of <br /> 837 Shaw Road - Stockton, California- 95215- (209)467-1006- Fax (209)467.1118 _ (� <br /> ClientProject Manager <br /> S✓'` PZ�1 r` �{r-1 i ,/l�,. Tests Required <br /> Phone Number <br /> 0 <br /> Sampl rs: ignature) ^�� Invoice: <br /> 0 <br /> Project Name �� Client <br /> Sample Location No. of E <br /> � <br /> P�N►t th <br /> Sample Type � � <br /> Date Time Water Solid Notes <br /> Number Description Comp, Grab. Air Conts. V► <br /> U-7/020y Z-yvi *,zyo Y, 0. <br /> PL <br /> ST11�02oyo� 13Z�cw arc i'ar. r 111016 OL d`- <br /> DW-1/02,4yv Dome_-.47c cwel <br /> R i i hed ( r n ure) Receivedy: (Signature) Date/Time <br /> 163U <br /> inquished by: (Signature) Received by: (Signature) Dale/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) Date rime <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Date/Time 1- �C/Zo'l ?'L(AIL, <br /> Method of Shipment: Laborer Name // <br /> C ti l .Gc-Gi <br /> Special Instructions: I hereby authorize the performance of the above Indicated work. <br /> 51?I;c:_ l� <br />