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( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvxronmental Inc Date 5-r)6 Oc,) Page of <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> Client Project Manager <br /> ° 1 I �e �`�; Tests Required <br /> Phone Number ^tL <br /> Samplers (Signature) Invoice <br /> Project Name f ��I AGE g[' <br /> Client ❑ <br /> Sample Location Sample Type <br /> Number Description <br /> Date Time Water Air Solid C°1°s Notes <br /> Comp Grab <br /> co <br /> al 10 <br /> M -v1) <br /> e tnquts e y tgnature F ecetve y rgnature <br /> '.n ,tia f `7 j k , C dell, <br /> Date/Time <br /> Relinquished by (Signa re) Recetved by (Signature) <br /> Date/Time <br /> Relinquished by (Signature) <br />� Received by Mobile Laboratory for field analysts (Signature) Date/Time <br /> I <br /> Dispatched by (Signature) DatelTime Recetved for Laboratory by DatefTime <br /> Method of Shipment Laboratory Name <br /> y" lCt�k 0 A 14, { ,, �{C <br /> Special Instructions I hereby authorize the performance of the bove indicated work <br /> �i � <br />