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O <br /> Advanced CHAIN OF CUSTODACORD <br /> GeoEnvzronmental, Inc. Date Page of <br /> of Northern Cafrfonua ; <br /> 1803 West March Lane, Suite A Stockton California-95207 (209)956-0264 Fax(209)956.0700 Q4Q x AG : 76251 <br /> 1 � <br /> Protect Manager Tests Ren <br /> 78252 <br /> Y2 4a <br /> Phone Number <br /> 78253 <br /> t <br /> Samplers (Signature) / invoice <br /> Project NameAGE [� <br /> It H Client ❑ <br /> Sample LocationSample Type No of r t <br /> Number Descrl tion Date Time Water Solid 78254 <br /> p Comp Grab Air ContS t i <br /> t <br /> i <br /> P4 f fir- 9? G13T �° X 8 5 <br /> e i F e y +gn t re} e y ignatur 7_ oZ -97 Date/Ts <br /> &P%;) ,� ) '/ �� 16 % XaMr <br /> � <br /> Relinquished by (Signature) ed by (Signature) � Date/Time <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 /> Method of Shipment Labor tory Name +� <br /> G [/ <br /> Special Instructions I hereby <br /> authorize the performance of the above indicated work <br /> f` W <br />