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CHAIN OF CUSTODY RECORD <br /> Advanced <br /> GeoEnvironmental, Inc Date G_of-2 l-G Page --L— of—k-- <br /> 4005 North Wilson Way-Stockton,California 95205-(209)467 1006-fax(209)467-1118 <br /> ClientProject Manager <br /> Tests Required <br /> LJ, I I,'r"n' <br /> Phone Number <br /> .2019 9("? - X006 <br /> Samplers (Signature) ,r Invoice <br /> Protect Name AG I.Client ❑ <br /> Sample Type <br /> Sample Location Date Time Water Solid No of Notes <br /> Number Description camp Grab Air Conts , <br /> 0q-)1-lam 15.00 X <br /> �n I�."� T !e. SvcUn 11+ � 48341 k <br /> IMP— FRESE U,IMON <br /> HCAQ SPACE ABSENT CONTAI 0S <br /> e e y net re ei y ins r DatelTime <br /> Relinqu,shed ign !>Wed by (Stgnalur ( DatelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) [ � Date/Time <br /> Dispatched by (Signature) Date/Time eceived for Laboratory by ( Date/Time <br /> Method of Shipment `` Laboratory Na ] <br /> Co, I o LJ e r n ' - owtt <br /> £ •PrCst•• G <br /> S ectal Instructions _ I hereb authorize th performance of the above indicated work <br /> p IV �� _ _ f r}�I'' i�l11CIIN _r I <br /> ..J �aiLLs I ) — i ,J, Vi�W iii` <br />