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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc Date �� U1.- Page Z of �-=" <br /> 837 Shaw Road Stockton, California-95215- (209)467-1006 - Fax(209)467-1118 <br /> Client Project Manager Tests Required <br /> P one Number <br /> 2, -Oc. H 6-Z-- IW6 <br /> Samplers (Signature) Invoice <br /> Project Name -` , AGE Z' <br /> Cl✓�►� �b �`I Client ❑ <br /> Sample Type <br /> Sample Location No of �� <br /> Number Description Date Time Water Air Solid Conts Notes <br /> comp Grab � I <br /> tw /kA <br /> Relinquished y ( i n t Received by (Signature qatetTiT <br /> U t 166?1�1 <br /> Relinquished by (Signature) Received by (Signature){}-� DatefT a <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) \ DatelTime <br /> Dispatched by (Signature) DateJTime Received for Laboratory by DalerTtme <br /> .12-h Z u3 :0 <br /> Method of Shipment Labo"alo Name <br /> caA ti 1J�4 <br /> Special Instructions Wv L CO L � y 1 hereby authorize the performance of the above Indicated work <br />