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R2Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date 1 1(7 ? Page -'of 414 <br /> 837 Shaw Road-Stockton, California-95215 - (209)467-1006 - Fax (209)467-1118 <br /> Client Project Manaer l I <br /> l� rahj b Tto . Tests Required <br /> Phone Number <br /> Samplers: (Signature) }�' 1� Invoice: <br /> Project NameG T I if AGE-p <br /> Client ❑ <br /> Sample T <br /> Sample Location p YPe No. of � <br /> Number Description Date Time Water Air Solid Conte. Notes <br /> Comp. Grab. <br /> Two - E Tflnk I �i�h— `i�� 1 r��� ice-.3s ✓ I � x k <br /> TJJ-\I^ -(A I, i()' 3 z, I X <br /> S i S ;� Fh Nix 11iL ( (i ' �t� �` ✓ t CLRti �s r <br /> elmgws e_ y: ignat eceivs y: rgneture Da /Time <br /> II rf <br /> Relinquished by: (Signature) 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 Received for Laboratory by' ) Dals/Tims <br /> Method of Shipment: ON <br /> Lab(/story Name - <br /> Special Instructions: I hereby " thorizs the performance of the above Indicated work. <br /> cr / fi C 11� j I . <br /> +� c � � �;1� - � l <br />