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( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date //-1"a3 Page of z <br /> 837 Shaw Road-Stockton,California-95215- (209)467-1006 - Fax(209) 467-1118 f f r <br /> Client Project M; ager <br /> Tests Required <br /> Phone Number <br /> At 7 /od <br /> Samplers (Signature) 5 Invoice <br /> Project Na , �� b�' Client me <br /> t PA C16 7(U(- ?) AZAEl <br /> Sample Location Sam le Type No of J <br /> Number Description <br /> Date Time Water Ar Solid ContS q �� v Notes <br /> Comp Grab f` / /\ <br /> i wz I f ►k. t�z_ X313 / <br /> 6147 l <br /> mwq 1261d <br /> e i is e y r nature) e—Ge ive y ignature Da /Time <br /> Relinquished by (Signature) Received by (Signature) Bateffirne <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Received for Labora3gry bye/ DalelTime <br /> � J <br /> Method of Shipment . Labor ry Name <br /> it <br /> + r i <br /> Special instructions �Ce� �l� � // I hereb uthorize the performance of the ebov indicated work <br />