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i <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnyironmental, Inc. 07—/ 7 <br /> ate 2 -`YPageOf <br /> 837 Shaw Road-Stockton, California- 95215- (209)467-1006- Fax (209)467 1118 C'7 <br /> Clientg P ofect Manager� <br /> Tests Required <br /> P one N ter <br /> P06 <br /> Samplers (Signature) Invoice <br /> Protect NameAGE <br /> AaL r � Client � <br /> Sample Location Sample Type Solid No of Nates <br /> Camp <br /> Number Description Date Time Water Air ContsLl <br /> Grab <br /> 1 <br /> ,Q z P" 2 t)5 L XY XX <br /> .�JT75 tlk\A) `3 <br /> �w W 0,`l 3' <br /> ova v <br /> e unguiureffece—ovea y ignature Dat !Time <br /> `7 � a 7 <br /> Relinquished by (Signa ure) Received by (Signature) DalelTim <br /> Relinquished by (Signature) Received by Mobile Laboratory for lieid analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Received for La rat by ate[Time <br /> 7 z7 0 p <br /> Method of Shipment L oratory Name <br /> C' b ci ` <br /> Special Instructions �� �� I hereby authorize the performance of the above indicated work 1 <br />