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v Y� <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. date 7 z.� 7 page <br /> of Northern Calrfonna <br /> 1803 West March Lane,Suite A-Stockton,California-95207-(209)956-0264-Fax(209)956-0700 f QJYXa D <br /> Project Manager <br /> Client L , l(� Ll 7-77F, <br /> Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> AGE <br /> Project Name 1t J� Cilent <br /> W <br /> Sample Location Date Time Sample Type Water Solid No of Notes <br /> Number Description Alr Conts <br /> Comp Grab <br /> _ r <br /> e inqui� e y (Signatu ) y� ignatur ���(�_ DatelTime <br /> Relinquished by (Signature) eived by (signafur& DalelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Received for Laboratory by DatelTime <br /> Method of Shi aril — Lab ry Nam <br /> i <br /> lV� <br /> Special Instructions I hereby authorize t porforman a of the above Indicated work <br /> nr1�"T'i APPPOMA - <br />