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( Advanced CHAIN OF CUSTODY RECORD <br /> --=- GeoEnvironmental, Inc. Date I Page 3_ of- <br /> 4005 North Wilson Way-Stockton,California-85205-(209)467-1006-Fax(209)467-1118 <br /> Client Protect Manager <br /> 000 � l�A � �c� C Tests Required <br /> Phone umber F <br /> ZUr-i - V 6 F <br /> Samplers (Signature) Invoice <br /> AG E�k <br /> Protect Name <br /> C14L.- <br /> �� � Client ❑ <br /> Sample Location Sample Type No of <br /> Number Description Date Time Water Air Solid Cants ti N Notes <br /> Comp Grab <br /> Vv 1 7 Mc�li}af i� Luh 1<l_. , 13 r <br /> rv1uu � � � 0 <br /> Aw� a r t F' <br /> r , <br /> I v� ti 3 -ci5 � <br /> it <br /> 95 P- 65 <br /> TT <br /> e i uis e b ( rgnatureReceived y (Signature) Daterrime <br /> Relinquished by(Signature) Received by (Signature) Date/time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date(rtme <br /> Dispatched by (Signature) Date[Time ceive for Laboratory DatG[Time <br /> h� 4 3 00j02" <br /> Method of Shipment i Laborat ry Name JJ <br /> v c S <br /> Special instructions I hereby authorize the performance of the above indicated work <br />