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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnv>ironmental, Inc. Date LZI'O3 Mage of 3 <br /> 837 Shaw Road - Stockton, California-95215 - (209) 467-1006- Fax (209)467-1118 Ut <br /> Client ✓ Project Ma er <br /> rR 7n Tests Required <br /> Phone Number <br /> VG 7-idd 6 <br /> i <br /> Samplers (Signature) Invoice <br /> Project Name � <br /> eC AGE� <br /> r'4 f 1 b Client ❑ <br /> Sample Location Sample Type No of <br /> Number Description Date Time Water ra� Air <br /> Solid Conts N Nates <br /> Comp <br /> a92-fz: /2-3 3 3 I <br /> Zlu ky ( ature 094 lReceivedy ignature) Date/Time <br /> ee_�� 9-z`(-03 146410 <br /> Relinquished by (Signature) Received by (Signature) Datef erne <br /> Relinquished by (Signature) Received by Mobile Laboratory for held analysis (Signature) C I 1 Date(Time <br /> Dispatched by (Signature) DatelTime Received for Laboratory by .. ; DatelTime <br /> Method of Shipment — A Lahor r am J <br /> special instructions J � �// I hereb authorize the performanceof !h above indicated work <br />