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( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. (A-0 C— Date ' Page C Of <br /> 837 Shaw Road- Stockton, California-85215- (208) 467-1046- Fax(209)467-1118 <br /> Client Project Manager <br /> Tests Required <br /> Phone Number <br /> Samplers (Signature) Involce <br /> U <br /> Project Name r AGE <br /> ! �I�� m 1& ` �(� Client ` <br /> Sample Location Samp a Type <br /> Number Description Date Time Water Solid No of Notes <br /> Comp Grab Alf CiQr]t5 i <br /> -71406 073509 X1 1 <br /> f <br /> r~i ZVO/ 14 ' _ 73510 _ <br /> 73511 <br /> J 1 <br /> 73512 f <br /> 73 513 - <br /> I�'lcv� 314 73514 't <br /> Re e 7y tura ace ve y (Signature) <br /> mOate/Tlma <br /> Relinquished by Sig l—ufel Ived by {Signature) ��� Date me <br /> 10#�ETALSJOTHER <br /> r , <br /> Relinquished by (Signature) r1 �c by M re) DataJTima <br /> 0D Go�ti�: �� ROPRIAT <br /> f R <br /> Dispatched by (Signature) r'--111 D Received for Laporatory by D telTime <br /> �zct� Q'l /aClp <br /> Method of Shipment Labdfatoty Name <br /> C. ynAsz <br /> Special Instruction%--'- hereby authorize the pertormance of the above Indicated work <br />