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( Advanced CHAIN OF CUSTODY RECORD <br /> c <br /> GeoEnvironmental, Inc Date �3 Page of <br /> 4045 North Wilson Way-Stockton California-95205 209 467-1006 Fax 209 467-1118 <br /> Client Project Manager <br /> ??ILL 4.m&, Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> , C� AG E <br /> Project Name r (Ail '� Client ❑ <br /> Sample Type <br /> Sample Location Date Time Water Solid No of Notes <br /> Number Description Comp crab Air Conts r <br /> r1 35.125 <br /> 2_5 <br /> 1235 <br /> _12 6 r <br /> 35128 <br /> 35130 <br /> 7 Za <br /> r 35131 <br /> hnq is e y ( Ignature) Zve (Signature) untelllme <br /> Rehnqur ed by (Signature) Received byy ( � ���"at re) � � OatelTlme <br /> 1�h,�t'q+L�tlifyr,IC� <br /> I <br /> Relonquished by 4(Signature , R cerLv ¢y_M"ile-Moratory for field analysis (Signature) Date/Time'�S <br /> Iw <br /> k Olspatche 1 lg r fiVr; Date/Time R o e for L@boratory b _ nato�Tlme <br /> asaa co����,��,�,�i�_--- <br /> Method of Laboratory Name <br /> M lq-T� <br /> Special instructions _ I hereby authorize the performance of the above Indicated work <br />