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CHAIN+0USTODY RECORD <br /> Advanced -W <br /> t © / <br /> Date Page of <br /> --- GeoEnvi<ronmental, Inc. <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 _ <br /> ClientNM?0 Project Manager Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> " <br /> Project Name AGS <br /> Client ❑ <br /> Sample Location Sample Type No of <br /> Date Time Water Solid Notes <br /> Number Description comp Grab Air Conts <br /> Ire VUA% � 96249 <br /> e inquia b y J gnatu a starve y ignalure Date/Time <br /> �— <br /> Relmq shed by (Signature) Received by (Signature) r Dateffime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date(Time <br /> Dispatched by (Signature) Datefrime Reciiyvlor Laboratory by " (+� / Date/Time U, -X A(� ��I �ft <br /> Method of Shipment Labotalo y Name <br /> Special Instructions 1 hereby 4Wlh0rize the performance of the above indicated work <br /> VX 016 METALS OTHL <br /> �v <br />