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( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. 3 (� Date (` Page __I__ - <br /> 837 Shaw Roar!-Stockton, California- 95215- (209) 467-9046 - Fax(209) 467-1118 <br /> er <br /> Project Manager <br /> Client Tests Required <br /> #' ane umber <br /> Samplers (Signature) �a Invoice <br /> Project Name � � , AGE SS(' <br /> Client ❑ <br /> Sample Location Date Time Sample Type No of ��� /,� � <br /> Water Solid Nates <br /> Number Description comp Grab Air Conts <br /> '2- X X <br /> w 2- 3 MW 26-Wi <br /> inquis a gnat a Received y ignature p telTi a <br /> .!;(61y, -/�3�-) <br /> Relinquish by (Signature) Received by (Signature) Datelfime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) STIATN ' DatelTime <br /> Dispatched by (Signature) Date/Time As v r Laboratory by I D ta/Time I�t <br /> ao�o <br /> Method of Shipment we RECD SEALED &INTACT VIA abcratory Name <br /> spsclat Inatructlons 1k, i ��. ✓ 1 hereby authorize the performince of the above Indicated worts { <br /> //►V/ iCFJt° <br /> -QQQD.CON <br /> 17ITK PPOPRIAT]3 <br /> HEAD 5PACE ASSENT <br /> DECHLORINATED IN LA 4 PRESERVED IN LAB__�_.,� <br /> PPX8RRVATI0N <br />