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1. <br /> Advanced CHAIN OF CUSTODY RECORD <br /> Date _0q Page __!V of <br /> GeoEnvironmental, Inc. <br /> 837 Shaw Road Stockton, California - 95215 - (209) 467-1006- Fax (209) 467-1118 r —7 <br /> t ecna <br /> Client Pro� � �x✓5h� - / � er g�J 54 � Tests Required <br /> Phone Number <br /> V <br /> Samplers: (Signature) �� Invoice: <br /> Project Name <br /> AGE <br /> 5�b COn e-k'-- Client <br /> Sample Location Sample Type No. of <br /> Number Description Date Time Water Solid Notes <br /> p Comp. Grab. Air CDr1tS. <br /> o / /� I <br /> a 3 <br /> "6U) lal6b X <br /> e i ed by: ignature) eceiva y: tgnature Date/Time <br /> 6", —3-6y <br /> Relinquished by: (Signature) Received by: (Signature) Data/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) DateTime Raceived for Laboratory Date/Time <br /> Method of Shipment: Y /l ory Name <br /> Lab tG <br /> Lo <br /> C <br /> Special Instructions: hereby authorize the performance of the above indicated work. <br />