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( Advanced CHAIN OF CUSTODY RECORD <br /> _ GeoEnvironmental, Inc. Date �� zr �``� Page �_ <br /> 837 Shaw Road- Stockton, California • 95215 - (209) 467-1006 - Fax (209)467-1118 <br /> Client ` Irl Project Manager <br /> Tests Required <br /> P ne N tuber <br /> Sam rs: (Signature) ��✓ Invoice: <br /> Project Name �' cD <br /> 1 ,s t,, r ` AGI <br /> �7r� Client ❑ <br /> Sample Location Sample Type No. of f <br /> Number Description Date Time Water Solid N Notes <br /> Comp. I crab. Air Conts. <br /> A E �a Z� �, LL i IN [ z R <br /> u <br /> V119 >C <br /> V�l►'� �.0iz k k x x <br /> el is a y: (Signature) ecerve y: 1gnature DatelTime <br /> o'ztvs t <br /> Relinquished by: (Signature) t-3G Received by: (Signature) Datattime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signatum) Date/Time <br /> Dispatched by: (Signature) DatelTime Received for Laboratory by: / Date/Ttme' <br /> Method of Shipment: Labp ory Name a <br /> C1*111d, �� 1 ,� LP ,� <br /> U- <br /> Speciel Instructions: (` U 1 her uthorize thene of th bove indicated work. <br />