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( Advanced CHAIN OF CUSTODY RECORD' <br /> GeoEnvironmental, Inc. Date .�- Page of__�-_ <br /> �r <br /> 637 Shaw Fload-Stockton, Callfornla-95215-(209)467-1006-Fax(209)467-1118 O <br /> Client t-"A C1 A Project Manager Tests Required <br /> A N kcl, 6nc- <br /> Phone Number <br /> 1�� ®� <br /> Sam IerS (Signature) Invoice <br /> Project Name AGE 4R-2 <br /> M Ab r � 5 a b Client ❑ <br /> Sample Location Sample Type Na of �` s <br /> Date Time <br /> Number Description Comp Grrab Air solid Corns Notes <br /> M w! <br /> �f1� Qin Zya j <br /> e mquishod by (Signature) eceiva y'-Mignatur-91 Date/Time <br /> Relinquished by (Signature) Received by (Signature) Datelrims <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatafTime <br /> Dispatched by {Signature) Date/Time Received for La(7tory DatelTima <br /> W TA/C� <br /> Method of Shipment � t.aab <br /> Special Instructions i hereby uthorize the performance ofthe ova Indicated work <br /> r <br />