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CHAIN OF CUSTODY RECORD <br /> Advanced Ap"hUS <br /> Date /2--2-7--R—page <br /> GeoEnvironmental, Inc. L�11 <br /> _�. 837 Shaw Road -Stockton, California- 95215 - (209) 467-1606 - Fax (209)467-1118 <br /> Client �' ��- � `� � Project r Manager Tests Required <br /> Phone Number <br /> S rs (Signature) Invoice <br /> Project Name , - AGE <br /> C L _ dpi,� i� .�, <br /> Client ❑ <br /> Sample Location <br /> Sample Type <br /> No of <br /> Number Description Date Time Water Air Solid Conts Notes <br /> Comp Grab <br /> ,z-�t,-dam <br /> e inquis e y ( ign tura eceive y ignalure �� <br /> Dateffime <br /> C ,tr l <br /> Relinquished by (signature) Received by (Signature) DatelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatelTime <br /> Dispatched by (Signature) Date/Time Received for Laboratory by / Dat /Time <br /> Method of Shipment ii}va hT— a orator flame <br /> Special Instructions I hereby authorize the erformance of the above Indicated work <br /> r f k\A3 �L =P"--�e'l - OW4 <br />