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{ Advanced CHAIN OF CUSTODY ECORD <br /> 2 — � of <br /> c _ Date 11 I _ �� Page <br /> GeoEnvirotimental, Inc. <br /> 4005 North Wilson Way-Stockton,California 95205-(209)467-1006-Fax(209)467 1118 <br /> Client Project Manager Tests Required <br /> Phone Number <br /> Z - <br /> Samplers (Signature) Invoice <br /> AG EX <br /> Project Name `-� Client ❑ <br /> Ir <br /> Sample Location Sample T06 No of �' �' Notes <br /> Number Description Date Time Water Air Solid Conts <br /> Comp Grab <br /> L`' Maf,r�prrn well -tr' �, II-2j-9� BRAsS <br /> W�~ a `r 2 ' -1 1 ' <br /> tt ft " it r <br /> Mtu tr t 1 `Z <br /> r <br /> Al <br /> -FRIefin quis a U14 <br /> gnatture) Receivedy (Signature) 'Z���NQAQ� Date/Time r <br /> -00 <br /> Rel��, uun hed by (Signature) Received by (Signature) Date/Tim <br /> mq <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysts (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time ecery for Labo or bye Date/Time <br /> r s s �o�s <br /> Method of Shipment La oratory Name <br /> c a -0�-k Z <br /> Special Instructions I hereby authorize the performance of the above Indicated work <br />