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j Advanced CHAIN PF, CUSTOD•Y RECORD <br /> GeoEnvir��nmental, Incga? i I �,, f Date Page --I— of <br /> 4005 Horth Wilson Way-Stockton,Cafifornia 95205 (209)467-1006-r-ax(209)467 1118 <br /> Client Project Ma er <br /> Tests Required <br /> P one Number <br /> 10 7 <br /> rs (Signature) Invoice <br /> Project Name�iA AGE-* <br /> Client ❑ <br /> Sample Location Sample Type Date Time No of <br /> Number Description Water Air Solid Conts Notes <br /> Comp Grab <br /> .w <br /> 11/0 3 52351 <br /> 52352 <br /> P IrULM H TAS1 d&G NIFT S TO <br /> GD :DCO1,@ 101V A PRC IRIA <br /> a n os e ygureReceived y gnatu a DateTrime <br /> Relinquished by (Signat a Received by ignature) Date/Time <br /> Relinquished by (Signature) Received by Moble Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date1Tlme Received for Laboratory by �l ❑�telTkme <br /> Method of Shipme Laborelory gL <br /> Special Instructions I here y auth rize th rform ce of the above Indicated worts <br /> 4 <br /> 1� ! <br /> J <br />