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Advanced CHAIN OF CUSTODY RECORD <br /> t 9 <br /> GeoEnvironmental, Inc. Date �� 03 Page —t— Of <br /> 837 Shaw Road-Stockton, California- 95215- (209)467-1006- Fax 1209)467.1118 <br /> Client �� �' _ Project Manager V'C' <br /> ', } Tests Required <br /> V'C <br /> Phonk Number <br /> Samplers: (Signa ure) p� Invoice: <br /> Project Name AGE D (� �]�r _. G Client 5 <br /> `[ <br /> Sample Location Date Time Sample Type Solid NO. of Notes <br /> Number Description Water Air Conts. <br /> Comp, Grab. <br /> 8 � . <br /> .311003 44 Z Y If 01 <br /> T r iboa ! x <br /> I co 1� I DO X 1L- <br /> [� r 020 �` 1 <br /> J G`'ZS 1 <br /> 10-35 ?c . 1 L, <br /> Dry x r <br /> Re4m vas a y: (Signature) ecewe y: (signature) Daterri e <br /> v.3� 31?- b.3 3 <br /> Relinquished by: (Signature) Received by: (Signature) Date ime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for lield analysis; (Signature) DatelTime <br /> Dispatched by: (Signature) DatetTime Received for Laboratory by Datelrime <br /> Method of Shipment: Labo ory arae <br /> eek <br /> Special Instructions: t hereby authorize the performance of the above indicated work. <br />