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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date l k-0 7-o 0 Page Z. of _Z <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467 1006-Fax(209)467-1118 <br /> Client 4'1� Project Manager�♦ �r ��1 z e Tests Required <br /> r <br /> �� o Phone Number �k <br /> Samplers (Signature) �� Invoice- <br /> Project Name AGE <br /> LACO <br /> Client ❑ <br /> Sample-T <br /> Sample Location Date Time Water Solid No of Notes <br /> Number Description comp arab Air Conts <br /> 52458 <br /> Awl I10i.06 )MLS - V Lj-x r <br /> r �( 52459 <br /> r <br /> u� he y ignReceived y ignature C � Date/Time <br /> Ra quashed by (Signature) Received by (Signature) Date/rime <br /> Relinquished by (Signature) Received by Mobile Laboratory for Held analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time feceived for La <br /> bo ator by — `V � Date/Time <br /> �'� � <br /> +Inti✓ i�� I��� <br /> Method of Shipment Laboratory Name <br /> a1,r1 , L' <br /> Special Instructions y'nn&� METAL TIP I hereby authorize the performance of the above indicated work <br /> i YU tJ V' <br /> GOOD COND1Il0NAPPROPRIATE <br /> HEWTAUI 1113,21Y <br /> fNERS <br />