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( Advanced CHAIN OF CUSTODY RECORD <br /> ---_ %'- GeoEnvironmental, Inc , Date Page / of 1- <br /> 837 Shaw Road - Stockton, California 95215 - (209) 7-1006 - Fax(209) 467-1118 <br /> I <br /> Client Project Manager Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> W] <br /> Project Name � L AG E ' <br /> � <br /> Client ❑ <br /> Sample Location Solid Sample Type No of Notes <br /> Number Description Date Time Water Air Conts f <br /> Comp Grab <br /> i <br /> deice-5'a"7- d / .40" <br /> "VIIJ , c9`7 r 1,5-12- <br /> 1J( <br /> 0 <br /> e rnq ed by (Signature) a the y tg.nature - '� �Z fJale�Time <br /> Rel shed b igna(Ute) Received by (Signature) r�� Date(Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Dateffime Received for Laboratory by Date/Time <br /> Ir­�tnfllillr <br /> Method of Shipment <br /> J v�LYL, i i i Laboratory a e <br /> 11�'�Tlt CON <br /> Special tnatructlons CTVM G01"PT1, i — t',T.1,. Y f hereby eut nxe the performance of the above Indicated work <br /> n US <br /> 3 <br /> -T—/ —rt l 4)1_1t �l a r / <br />