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1 <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. /� _ r Dater Page _� of�___� <br /> 4005 North Wilson WayStockton,- t ,California 1352/5 (2/9)467-1006 Fax(209)467-1118 <br /> Client r Project Manager Tests Required <br /> iIt U41�� <br /> Phone Number <br /> zlm 0 � � <br /> Samplers: (Signature) ��' Invoice: <br /> Project Name AGE --R <br /> 7a�1 Client ❑ <br /> Sample Location Sample Type No, of ,'✓ <br /> Number Description Date Time Solid <br /> j Comp. Grab. Air Conts. Notes <br /> �fcl 14 40585 <br /> 40586 <br /> "00 � 40587 <br /> 40588 <br /> r- <br /> —Metingws a Y:I( ignature) Hecelved by: (Signature) <br /> pate/T'me <br /> no is ed by: (Signature) Received by: (Signature) Date Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Data/Time <br /> Dispatched by'. (Signature) Date/Time Recelved for Laboratory by: Date[Tlme <br /> 1 V <br /> M ho of Shipment: l �, Laboratory Name �r Iff <br /> OUC <br /> Special Instructions: I hereby authorize the y performan a of the above indicated work. <br /> t,\w <br />