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f' Advanced CHAIN OF CUSTODY RECORD <br /> --- ,. <br /> GeoEnvixonmentai, Inc. Date –6– 7 / Page <br /> of—L <br /> of Northern Califonua <br /> 1803 West March Lane, Suite A-Stockton, California-95207-(249)9560264-Fax(209)956-0700 9 78-7xA G a <br /> r f <br /> Client U C Project Manager <br /> { ; Tests Required <br /> -' Phone Number 261- U6-OMLI <br /> Samplers: (Signature) Invoice: <br /> Project Name { t � �, , AGE <br /> Client ❑ <br /> Sample Location Sample Type �,� <br /> Date Time Water Air Solid Co. of �� Notes <br /> Number Description ; <br /> Co -mGrab. <br /> r <br /> f <br /> e i use y: ( ignalure -- Received y: tgnature DatelTime <br /> Relinquished by: (Signature) Received by: (Si ature) Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) DatelTime <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Date(Time <br /> Method of Shipment: Laboratory Name <br /> Mc C a e <br /> Special Instructions: / I hereby authorize the perform nce of the above indical d work. <br />