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I <br /> i CHAIN OF CUSTODY RECORD <br /> Advanced ZZ- <br /> Date E�`��2 Page of <br /> GeoEnvironmental, Inc. <br /> 837 Shaw Road - Stockton, California- 95215- (249) 467-1006- Fax (209)467-1118 <br /> Client1+1 � Project Manager Tests Required <br /> Phone Number <br /> eao <br /> Samplers (Signature) L7 Invoice <br /> ;9;-- 4 <br /> �{ AGE <br /> Project Name ,M GL 'A+e-co� X Client ❑ <br /> Sampe <br /> Sample Location No of <br /> Number Description Date Time Water Air Solid Cants � � Notes � <br /> Comp Grab <br /> n1g 1ZngoZ <br /> I <br /> el, s ed y Mynat.re) ecerve y-(9-1gnatureI� Date <br /> It .,shed by (Signature) Received by (S,gnature) <br /> Date/Time <br /> Relinquished by (Signature) Received by Mobile laboratory for field analysis (Signature) Daterime <br /> Dispatched by (Signature) <br /> Date/Time Received for Laboratory by DatelT,me <br /> i, <br /> I r f s <br /> Labpralory Name <br /> Method of Shipment <br /> — Dv-er nr kt f c <br /> Special Instructions I hereby authorize the perfor ante of the above Indicated work <br /> a <br /> r <br />