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Advanced CHAIN OF CUSTODY RECORD <br /> Date 71" Page I/'— of <br /> GeoEnviron mental, Inc. <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-�A,(209)467-1118 <br /> Client - ' Pro' t Manager <br /> IU,(fnf-2 Tests Required <br /> Phone Number <br /> 04,ff- tz4,J; Samplers: (Signature) <br /> Invoice: <br /> Protect N arne AGE , <br /> Ef' <br /> Sample Location Sample TypeDate Time Water Solid No. of <br /> Number Description Comp. Grab, <br /> Air Conts, Notes <br /> 4- 434-0-1 <br /> 43404 <br /> Rfl1jqPL'61e Y: n to Received by: (Sign- <br /> tu <br /> ar. <br /> e/Time <br /> Relinquish re) <br /> 016914MM Dale/Time <br /> Signature) oratory for field analysis--(Signature) Date/Time <br /> ImFrljrL-- <br /> Dispatched by: (SigrrT Date/Time I Receiv forLaboratoryb <br /> M h7m _qd for D.t a f�T�i�..�.r <br /> 77 <br /> Method of Shipment: La t NP <br /> Special Instructions:Instructions: <br /> 71 hereby authorize the Performance of the above indicated <br /> f7 <br />