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r� Advanced CHAIN QF/CUSTODY RECORD <br /> j <br /> --- GeoEnvironmental, Inc. Date 2/ Page or <br /> 837 Shaw Road - Stockton,California- 95215- (209)467-1006 - Fax (209) 467-111 B ?c <br /> Client Project Manr'+ O Tests Required <br /> Ppione Number <br /> Sa s: (S' nature) Q{�/i Invoice: <br /> Project Name // AGE EM <br /> I <br /> / Client <br /> Sample Location Sample Type / <br /> Date Time Water Air Solid No. <br /> o is <br /> Number Description Motes <br /> Comp. Graf. <br /> ir <br /> b <br /> eingws e -�nal aecerve y: jgneture eta ima <br /> Relinquished Vi (Signatute) Received b (Signature)Y� ( 9 ) DatelTime <br /> Relinquished by: (Signature) Received b Mobile Laboratory for field analysis:Y 7 Y (Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by' Date/Tima <br /> Method of Shipment: Lab orya <br /> Lc� i J <br /> Special instructions: 1 hereby ut rize t p iforman s of the above Indicated work. <br /> c <br />