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t Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc Date Page of Z <br /> 4005 North Wilson Way Stockton,California 95205 (209)467 1006-Fax(209)467-1118 <br /> Client 12jin2 <br /> Project Manager <br /> &),k- 4 .� <br /> Tests Required <br /> P ne liumber <br /> r � � <br /> S ers Ignature) Invoice <br /> Protect Name AGE <br /> XPE1:�./� Q Client E:] <br /> Sample Type Y <br /> Sample LocationNo of <br /> Number Description Date Time Water Air Solid Cants Q Notes <br /> Comp Grab <br /> 17-00 <br /> I <br /> e inu e ig ature Receivedy (Signature Date/Time <br /> c <br /> Reli quashed by (Signature) Received by (Signature) ate/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) ate/Time <br /> Dispatched by (Signature) OatelTrme _77-1- <br /> ecewed for Laboratory by Dale/Time <br /> Method of Shipment Laboratory N m <br /> OAL 0 C2 EP &�9: <br /> Special Instructions I hereby authorize the performance of the above indicated work <br />