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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. F-ADate., mage 3 of 3 <br /> 4005 North Wilson Way Stockton,Califomla-95205-(209)467-1006-Fax(209)467 1118 <br /> Client Project Manager _r <br /> � Tests Required <br /> i <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> Project Name �A41�� r AGE <br /> !�'1'�J1 �/ ' Client ❑ <br /> Sample Location Sample Type No of <br /> Date Time Watef Solid Notes <br /> Number Description Air Copts � <br /> Comp Grab <br /> W410 <br /> z > 11 x 66131 <br /> �Yzyol L 1 / / ZD ► <br /> t 66132 <br /> _ � t <br /> Be tnquts y nature) eceive y tgnature f] tefrime <br /> Reltnq ed by (Signgrufef Received by (Signature) DatelTtme <br /> Relinquished b (Signature) ' <br /> q Y ( 9 ) Received by Mobile Laboratory for held analysts (Signature} Date/Time <br /> Dispatched by (Signature) Date/Ttme Received for Laboratory by DatelTtme <br /> / Y, ero �yPtr �I for r�.3ac�r} <br /> Method of Shtpm t Laboratory Name <br /> - WAS O&G METALS OTHER c (�A�g <br /> Special Instruc ons f I hereby author the performance of the above indicated work <br /> GOOD CONDITION APPROPRIATEr cc�Ied x tt,�ac. <br /> HU SP,"r �n�.-,,T j� <br /> �OTAf�IEp� �� <br />