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j Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvlronmental, Inc Date e4l)--°0_ Page -3— of <br /> 4005 North Wilson Way Stockton,California-95205 (209)467 1006-Fax(209)467-1118 <br /> Client e( n J Project Ma age Tests Required <br /> Phone Number <br /> AL r1ve, 0 <br /> Samplers (Signature) ``h Invoice <br /> Project Name �0� AGE <br /> Client [� <br /> Sample Type ; 0 <br /> Sample Location No of <br /> Number Description Date Time Water Solid Notes <br /> Comp Grab Air Conts <br /> M _ � <br /> 10 A D �16a X <br /> + 04 - 1S I V 1-7 <br /> X 1 �►al� <br /> kJ-�k NOJ-2 105- <br /> � X 1 <br /> v <br /> B3Va� _ <br /> e inquis a (Signature) eceive y ignature 5`�-� 13a1e17ime <br /> Relinquished by (Signature) �E Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Received for --a oratory by Date/Time <br /> Method of Ship Laboratory Laboratory N e <br /> olden vPT a A I <br /> Special Instructions I hereby a thori a the performant of the above indicated work <br />