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i i • <br /> ( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date _ Page of <br /> 4005 North Wilson Way Stockton, California-95205-(209)467-1006-Fax(209)467 1118 <br /> Client Project Manager Tests Required <br /> CJi ✓Yi LI <br /> Phone Number <br /> v� s <br /> Samplers (Signature) r r�� Invoice <br /> Project NameAGE <br /> Client ❑ <br /> Sample Location Sample Type No of <br /> Number Description Date Time Water Solid Notes <br /> Comp Grab Air Conts110 <br /> , <br /> } <br /> 1 60 40177 <br /> All I,;L t - y5r 40178 <br /> l '>•a y- I <br /> 40179 <br /> 40180 <br /> /A«-)1 LO lOro � r <br /> 4018 ? <br /> r 1 <br /> 1 <br /> eingis e y (signature) eceive y ignature Date/Time <br /> ' <br /> Relinquished by (Signatur6) Received by (Signature) Date/Time <br /> Relinquished by )Signature) Received bMobile l oratory for field analysis (Signature) DatelTime <br /> ki U0 --,kA <br /> Dispatched by (Signature) at rme Receive for laboratory by <br /> r DatelTime <br /> Method of Shipment t Laboratory Name <br /> Special lnsttuetions , ri tl I hereby authorize the performance of the above indicated work <br /> f <br />