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i <br /> Advanced CHAIN OF CUSTCO RECORD <br /> GeoEnvxronmental hnc. ©ate -� � Page of <br /> 4005 North Wilson"lay-Stockton,California-95205-(209)467-1006-Fax(209)467 1118 <br /> t <br /> Project Manager Ir <br /> Client , In Ell _ r S�� '� �!f Tests Required <br /> ��tm <br /> Phone Number 1_ <br /> } Samplers (Slgpature)' Invoice <br /> AGE <br /> Project Name _ fr -�t Ghent ❑ <br /> Sample LocationDate Time Solid Notes <br /> Sample Type No of / <br /> Number Description Water Comp Grab Air Conts <br /> e mquis e y (SignalureReceived y (Signature) <br /> ( DalelTrme <br /> Relinquished by (Signature) Received by (Signature) Date/Tim <br /> I <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DateJTime <br /> Dispatched by (Signature) Dale/Time Received for Laboratory by Date/Time <br /> I <br /> Method of Shipment _ r Laboratory Name r <br /> Special Instructions I hereby authorize the performance of the above Indicated work <br />