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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. 143 Date Page ,_.J_ of 2- <br /> 837 Shaw Road- Stockton, California 95215- (209) 467-1006 Fax (209)467-1116 <br /> Client—& Project Manager <br /> 14 <br /> Tests Required <br /> Phone Number <br /> CW17) Y- I CCI, <br /> Samplers (Signatur Invoice <br /> Project Name ;may tr <br /> AGE ,Q <br /> Client ❑ <br /> Sample Location Sample Type t`1 <br /> Number Description Date Time Water of Na of _ <br /> Comp crab Air Conts Notes <br /> 1gg3 c <br /> 2q / t <br /> I sJ <br /> c � <br /> � ick e z� —26 03 Vill I <br /> e y ature eceive y gna(ure <br /> DatelTim <br /> inquished by (Signature} Reoelved by (Signature) L + U <br /> ts/Trme <br /> Relinquished by {Signature) _ Received by Mobile Laboratory for field analysis (Signature) <br /> Dispatched b � Date/Trme <br /> p y (signature) Datelrime <br /> Received for oratory by <br /> DatarlIme !� <br /> Method of Shipment fir} Laboratory Name }3 ���OD <br /> Special instructions <br /> I hereby aut orize he performance of the above Indicated work <br />