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( 1 Advanced CHAIN OF CUSTODY RECORD <br /> = GeoEnvironmental, Inc. Date 2 Page of� <br /> 4005 North Wilson Way-Stockton California 95205-(209)467 1006 Fax(209)467 1118 <br /> Client Project Mana ier t <br /> Tests Required <br /> 1,44 <br /> r <br /> Phone N ber <br /> Sa (Si ature) Invoice <br /> Project Name AGE 0'QfZS Client ❑ <br /> Sample Location Sample Type Noof <br /> Number Description Comp <br /> Time Water Air Solid CvnNates <br /> Comp Grab + <br /> 40186 <br /> 1 <br /> 40187 <br /> t <br /> kyu -oz) lt '/ 101130 4 018 8 ' <br /> i + <br /> �- <br /> g&-a-00 0) �- 40189 <br /> i + <br /> e in i e y + natur eceive y ignsture DatelTlme <br /> Relinquished b (Signature) Received by (Signature) DatatTime <br /> Relinquished by (Signature) Received by obiie Laboratory for field analysis (Signature) atelfl a <br /> Dispatched by (Signature) �� De a Received for Laboratory by Uate ime <br /> Method of Shipment f_ Laboratory Nam f <br /> (oilr"1 ►,,mac,'! b p�lMJt I, ` <br /> Special Instructions I hereby utho ize the peri6fma ce of the above Indicated work <br /> - <br /> ot <br /> 1i�11i.1Jrltvi.,tiJ,,.,.r <br />