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Advanced CHAIN OF CUSTODY RECORD <br /> t ~-= - Dater ` ofGeoEnvironmental, Inc. Pae <br /> —�- <br /> of Nonhein Calrfomia <br /> 1803 West March Lane Suite A Stockton California 95207 (209)956-0264 Fax(209)956-0700 <br /> 11 <br /> Client L �� s' Project Manager. Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> AGE <br /> Protect Name � Client <br /> t'a,wt�UI- 1� <br /> Sample Type �� <br /> Sample Location — Solid No of \/ Notes <br /> Date Time Water <br /> Number Description Comp Grab Air Con / <br /> Rel, q s e y (Signal a Receive by (Signature) Date/Time <br /> Relinquished by (Signature) Receiv (Sign ture) Date/Time <br /> �- s-9 4 � <br /> Relinquished by (Signature) Recery obile Labor tory for field analysis (Signature) Date/Time <br /> i <br /> Dispatched by (Signature) J Date/Time Received for Laboratory by Datef ime <br /> Method of Shipment Laboratory Name <br /> CA- <br /> Special instructions 1 hereby authorize the performance of the above Indicated work <br /> W <br />