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j Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. ��,]/y�' Date Page I of �- <br /> r v�..r <br /> 4005 North Wilson Way-Stockton,Callfomla-95245-(209)467-1006-Fax(209)46 18 <br /> Client <br /> �i Project Manager <br /> �rx /M f.� !!1' .� Tests Required <br /> tO a K A, i <br /> Phone Number <br /> tJ t r iii} <br /> t� <br /> Samplers (Signature) ��' Invoice <br /> Project Name ` AGE <br /> I ../, Client ❑ <br /> Sample Location Sample type <br /> Number Description <br /> Date Time Water Air Solid o of Conts 1 , Notes <br /> Comp Grab <br /> i <br /> Mw - TO x )d 40160 <br /> /,LO . Ltd 40170 <br /> 1 <br /> /V1tv 10 40171 <br /> -90 33L, X 40 172 <br /> I <br /> y 40173 <br /> m�a 0 ,��} �� )K <br /> t 40174 <br /> e Inqut e yignature y <br /> ece ve y ignitors -y. 40175 <br /> Relinquished by (Signature) Received by (Signature) 1 <br /> DatelTime <br /> Rehnqulshed by (Signature) Received by obi a boratory fo d analysis (Signature) Date/Time <br /> Dispatched by (Slgnatufe) i Received for b Laboratory by I� DatelTime <br /> Method of Shipment ! Laboratory Nam <br /> }ve v <br /> Special instructions I hereby authorize the performance of As above indicated work <br /> 1"V <br /> ti ! -i-V L J <br />