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(' Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmentai, Inc. <br /> Date Page of <br /> 837 Shaw Road - Stockton. Callfornla-95215- (209) 467-1006 -Fax'(209) 467-1118 _Q �l <br /> Client �, � roject Manager � Tests Required <br /> G <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> Project Namep _ AGE ] <br /> Ra-POO DA Cr-FIC �` ,� Client <br /> Sample Location Sample Type No. ofi <br /> Number Description <br /> Date Time Water Air Solid Conts. Notes <br /> Comp. Grab. <br /> �!� � tv � ��zc i14 � ! • t, <br /> Wz�f k <br /> 29 e2 All <br /> 55 e30' i <br /> 5 7,U <br /> euis e y: (Signature) ecewe y: ignature <br /> < Date/Time <br /> Relinquished by: (Signature) Received b (Signature) �� <br /> Y ate/Ti a <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Date/Time <br /> F3 <br /> Method of Shipment: Laboratory NaMe <br /> QNB CAL i -W CNV; LAB <br /> Special Instructions: I hereby authorize the performance of the above indicated work. <br /> i <br />