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( Advanced <br /> CHAIN OF CUSTODY RECORD <br /> --_ GeoEnvironmental, Inc Date Page / of Z <br /> 837 Shaw Road- Stockton, California- 95215- (209) 467-1006- Fax (209)467-1118 <br /> Client / Project Manager <br /> G,e�1L Tests Required <br /> Phone Number <br /> Sample (Signature) Invoice <br /> Project Name AGE �. <br /> 7 <br /> Client ❑ <br /> Sample Type <br /> Sample Location No of <br /> Number Description Date Tune Water Air SolidNoNotes <br /> Comp Grab <br /> ,3 ,.1,k / .3 Ix <br /> .-� X <br /> "�� z 3 r✓ Jrs`� � -� X <br /> I <br /> e in ad byy lureReceived y (Signature) DalelTEme <br /> Re mquished by (Signature) Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) / Datefflme <br /> Dispatched by (Signature) Date/Time Received 1 aboral ry y DatelTime <br /> r q y� {u <br /> V f�f -7.-`J <br /> Method of Shipment Labo►at y Name <br /> i <br /> Special Instructions I her y a orize the performance of the above Indicated work j <br /> n <br />