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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date "g -d PageOf <br /> 837 Shaw Road - Stockton, California- 95215- (209)467-1006 - Fax (209) 467-1118 O� ' O <br /> Client - Proj Manager <br /> S Tests Required <br /> Phone _ <br /> S� piers: (Signature) Invoice: <br /> Project NameS �IL � / I e� bAGE <br /> y <br /> Client [- <br /> Sample Location Sample TypeDate Time No. of <br /> Number Description col��WateGrab. Air Solid Conts, ( Notes <br /> p." S (V— -�J�61uc I ) l 1 <br /> -a5 a <br /> - 3 C-6- <br /> quis a y: ( ign ) ecerve y: ignature Date/Time <br /> Re nquished by: (Signatu ) Received by: (Signaturs) / Date/Time <br /> :S <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> i <br /> Dispatched by: (Signature) Date/Time Received for Laboratory Date/Time <br /> Method of Shipment: Lab a ry me <br /> IT <br /> Special Instructions: ,.y n �� I hereby authorize the performance of the above indicated work. <br />