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f f C C L C C C f C C C f C C f C [ C <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, inc. <br /> 03 '-05y Date d Page 2 of <br /> 837 Shaw Road-Stockton, California- 95215- (209)467.1006- Fax(209)467-1118 <br /> Client � ,, Project Manager <br /> E NL ��]`i`t.Q �l� S Tests Required <br /> Ki�� + c+ <br /> Phone Number <br /> a,Q— r <br /> Samplers: (Signature) Invoice: <br /> Project Name AG E <br /> PA CI C T n Client <br /> 0 <br /> Sample Location Sample Type Date Time No, of <br /> Number Description Comp.Water Air Solid Conts. ! Nates <br /> Grab. <br /> 6.2 A010i 'y- t4In <br /> z C-2sf ; x y <br /> Z C A) <br /> 01103 I l u [34-5 h <br /> Relinquished y: (Signature) ecerve y: �gnature ate/Ti e <br /> r � 311 Z. <br /> Relinquished b ignature) Received by: (Signature) Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) f Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory Date/Tim <br /> Method of Shipment: Laboratory Nn <br /> Special Instructions: I hereby authorize the performance of the above Indicated work. <br /> l <br />