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( Advanced CHAIN OF CUSTOD RECORD <br /> GeoEnvironmental, Inc. Date PageOf- <br /> 837 Shaw Road Stockton, California- 95215- (209) 467-1006 -Fax(209)467-1118 <br /> Client _ Project Manager <br /> Gt(71 Test fR9qulred <br /> Phone Number �! <br /> Samplers (Signature) _ _ ,. Invoice <br /> Project NamAG E <br /> e <br /> A <br /> rt rM -1,4j7�t ����Li waa:,,. L:" , Client ❑ <br /> Sample Location Date <br /> p Sample Type <br /> Tune <br /> Number Description Water Air Solid C�ttsf r Notes <br /> Comp Grab <br /> W3 -2.9 1135 <br /> e Ipquif Received by (Signature <br /> Date rime <br /> Relinquished by (signature) Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatafTime <br /> Dispatched by (Signature) Date/Time Received for Laboratory by <br /> r Date/time <br /> Method of Shipment Laboratory Name y <br /> Special Instructions 1 hereby authorize the performance of the above Indicated work <br /> P✓L.S <br />