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t Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc <br /> Date Page —(-- of <br /> 837 Shaw Road- Stockton, California 95215 - (209) 467-1006- Fax (209)467-1118 <br /> Client Project Manager <br /> L Tests Required <br /> P ne Number <br /> X67(0 <br /> Samplers (Signature) Invoice <br /> Project NameAGE R< <br /> Client ❑ <br /> G /� <br /> Sample Location Date Time Sample Type Solid No of f <br /> Number Description comWat Grrab Air Conts � Notes <br /> I <br /> H-/;y )( X I X <br /> tom;>! <br /> Relinquished y r lure ecerva y jgnature Da /Time <br /> Relinquished by (Signature) Received by (Signature) DatelTr s <br /> Relinquished by (Signature) Received by Mobile Laboratory for fioid analysis {Signature) TA"T DatelTrme <br /> Dispatched by (Signature) Date/Time Received for Laboratory by Dateffime <br /> Method of Shipment Laboratory Name f <br /> Special instructions I hereby authorize the performance of the above Indicated work <br />