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� <br /> CHAIN OF CUSTO& RECORD <br /> Advanced <br /> GeoEnvironmental Inc Date � Page 2 of <br /> �-- <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467 1006-Fax(209)467-1118 <br /> Client Project Manager <br /> Tests Aegwreci <br /> Phone Number � <br /> 4, 7-hw <br /> Samplers (Signature) i Invoice <br /> AGEProject Name L x� -� CI ent� <br /> Sample Location Sample Type No of �` <br /> Number Description Date Time Water Air Solid Conts Notes <br /> Comp Grab <br /> Relinquished y ( ign re eceive y (Signature) Date Me <br /> ` Fdo 5-1 - t <br /> Relinquished by (Signature) Received by (Signature) Daterrime <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 /> Method of Shipment j y Laboratory Name <br /> Special Instructions / I hereby authorize the pert�an a of the above indicated work <br />