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t Advanced CHAIN <br /> t OF CUSTODY RECORD <br /> GeoEnyironmental, Inc. <br /> Date y'2 Page of <br /> 837 Shaw Road Stockton, California - 95215 - (209)467-1006 - Fax (209)467-1118 <br /> Client ProjejZt Manager <br /> V1 L1�C"f� Tests Required <br /> P one Number <br /> z )cic'-, - t00Ce� <br /> Sa le.rs: (Si nature) Invoice: <br /> Project Name AGE <br /> q <on (�' Client <br /> T <br /> Sample Location Date Time Sample ype Solid No. of Notes <br /> Number Description water Air Conts. <br /> Comp. Grab. <br /> �-2847-7 tv'Ir )-L otl-utac( Li �G <br /> Rqklinquls. natu ITecerve y: ignature-) Date/Time <br /> nquishe by: (Signature) Received by: (Signature) Date rime <br /> Relinquished by: (Signatu(e} Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Received or u hralory D to/Tima <br /> Method of Shipment: a Laboratory Name °^ <br /> _ Special Instructions: I her y t orixe th rmance f the above Indicated work. <br /> ■hJt �F\rr <br />