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Advanced CHAIN OF CUSTODY RECORD <br /> I �� 3 � <br /> --- GeoEnvironmental, Inc. Date Page � <br /> 837 Shaw Road- Stockton, California- 95215 - (209)467-1006 - Fax (209) 467-1118 _ 3 <br /> Client ProjeL Manager <br /> �-eTests Required <br /> Phone umber <br /> Samplers: (Signature) Invoice: <br /> ProjectName AGE <br /> L � g CCCcir� Client [� <br /> J I p .r <br /> Sample Location Date Time Sample Type Solid No. of Notes <br /> Number Description Water <br /> P comp. crab. Air Conts. <br /> 63— / , L/Z (O 1 o I <br /> 3 - Io kt (J oQ <br /> K 3 - /, �� t /S' to X <br /> 3 - c') 11 <br /> 3-3o <br /> e nq is a y: ( ignature ece vve y: ignat,ure Date/Time <br /> -�-dy <br /> Relinquished by: (Signature) Received by: (Signature) Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) DatelTime <br /> Dispatched by: (Signature) Date/Time Received for Laboratory Date/Tim q <br /> _U t / . <br /> Method of Shipment: L TRICITy Name <br /> Special Instructions: I her authorize the performance of the above indicated work. <br />