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CHAIN OF CUSTOD*ECORD <br /> Advanced Date g- - Page 6 of C= <br /> --- GeoEnvironmental, Inc. <br /> 837 Shaw Road-Stockton,California- 95215- (209) 467-10(}8- Fax (269) 487-1118 <br /> Client Project manager <br /> a�� r Tests Required <br /> �K <br /> Phone Number <br /> Samplers Signature) Invoice <br /> AGE <br /> — �Q D <br /> Project Name Client ED <br /> Sample Type No of <br /> Sample Location Time Water Solid '�` '� _ Notes <br /> Date <br /> Number Description comp Grab Air Copts <br /> 1 335 Y <br /> Datarri a � � <br /> Ze—l'inquished nat ecelva y ignature 9 Z_�5� j <br /> -T'— A. DatelTime <br /> n ei Received by (Signature) ! A <br /> nature DatelTi ma <br /> Relinquished by (Signature) Received by Mobile Laboratory for field enalyan (Signature) <br /> Dstafrime eived or Laboratory by �� Date/Time <br /> Dispatched by (signature) <br /> VW` <br /> Method of Shipment Laboratoams CRC f <br /> l^�t"'LI <br /> i hereby authorize the performance of the above indicated work <br /> Special Instructions "- <br /> rI1F/ <br />