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t l [ t t t t t t t t l t t t t [ t <br /> j <br /> CHAIN OF CUSTODY RECORD <br /> Advanced <br /> GeoEnvironmental, Inc, �� ' Date ` / Page ! of_� <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Pax(209)467-1118 <br /> ClientGUl�fjr �71/1Z7ZPI0/--SE- Pr ' nager <br /> h � ,+� Tests Required <br /> Phone Number <br /> Sam ers: (ISign Invoice: <br /> Project Name AGE-q--r� <br /> Client ❑ <br /> p <br /> Sample Location Sample Type No. of <br /> Number Description Date Time Water Solid Notes <br /> p Air ContS. <br /> Comp. Grab. <br /> M 1A) e 3�1 - 61278 <br /> VO S Q. qI <br /> GOOD CONDITI N JOW OPRIATE <br /> S <br /> e inqu a y: gnature ecevey: gnture Date/Time <br /> 11 lift '? <br /> Relinquished by: (Signa ure) Received by: (Signature) Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) (�� Date/Time <br /> Dispatched by: (Signature) Date/Time rjc7e ved for Laboratory Date/Time <br /> 2 <br /> Method of Shipment: Laborat <br /> Special Instructions: I hereby aut Ize the perlor ance of the above Indicated work. <br /> cA e <br /> i /A► <br /> l/�Q <br />