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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date nage <br /> 837 Shaw Road-Stockton, California- 95215 - (209) 467-1006- Fax (249)467-1118 <br /> Client Project Mana <br /> Tests Required <br /> uk-4n"Ac <br /> P ne umber <br /> Sa rs {S n lure) Invoice- <br /> Project <br /> � � � <br /> Protect Name � �Ut Client ❑ <br /> Sample Location Sample Typepate Time No o <br /> Comf <br /> Number Description Water Air Solid Cont s Notes <br /> p Grab <br /> 3— /v s3 <br /> 77f- -/63-4 <br /> I 11 <br /> x � 63�- <br /> e inq Is e (signature) ece ve y gnature a tarn e <br /> / 77,H� <br /> Relinq is ed by ( Ignat a Received by (Signature) tDatelTime <br /> Relinquished by (Signature) Received by Mobile laboratory for field analysis (Signature) 4atefrime <br /> Dispatched by (Signature) Date/Time Rec r Ls oratory b �yI /Time <br /> Method of Shipment ° labor to N <br /> v f-led I <br /> Special lnstructtra i hereby t Nze the Wformance of the above indicated work <br /> 5 <br />