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CHAIN OF CUSTODY RECORD <br /> AdvancedZ o0 /// <br /> Date 3 ' Page � of�--- <br /> --- GeoEnvironmentai, Inc <br /> 4005 North Wilson Way-Stockton,California 95205-(209)467-1006 Fax(209)467 1118 <br /> Clienta Protect M er Tests Required <br /> 2� `n ur 1A <br /> Phone Number <br /> UVL <br /> Samplers (Signature) r Invoice <br /> J AGE <br /> Project Name Client <br /> Sample Type Jn <br /> Sample Location Date Time Water Solid No of f Notes <br /> Number Description Comp Grab Air Conts <br /> -tom3-224' !9`6 3 fl <br /> LULELPn,IDate/Time <br /> inqu_s e y (Sig tore) eceave y ignature S U�-7 <br /> inquished b ( gn tura) 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 Laboratory by Date/Time <br /> Method of ShEjf& <br /> ens Laboratory Name - <br /> {/�r 37 1\ Af i, Anct f_1Cz <br /> Special Instructions I hereby authorize One performance ch the above indicated work <br /> Now <br />