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Advanced CHAIN OF CUSTODY RECORD <br /> - Date i"I Page� � of � <br /> " GeoEnvironmental, Inc. <br /> 837 Shaw Road-Stockton, California-95215-(209)467-1006 - Fax (209)467-1118 653 <br /> 3 <br /> er <br /> t Manager nag <br /> Client ����-�� ��y �.��:,� � Tests Required <br /> * <br /> PhoW Number <br /> Samplers (Signature) 4 Invoice <br /> } AGE <br /> Project Name VVAk° dil�j ���,.r���� <br /> ,� Client ❑ <br /> Sample Type <br /> Sample Location Date TimeWater Solid No of Notes <br /> Number Description Comp Grab Air Conts <br /> 3 k 10t� <br /> e rnqurs y ( ignatur ecerve y (Signature) Date/Time <br /> Relinquished by (Signature) Received by (Signature) DatelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatelTrme <br /> Dispatched by (Signature) Dale/Time Received for Laboratory v' DatelTime <br /> Method of Shipment - L&b6 Name <br /> � <br /> S Scta!lnsltuctlons i hereby authorize the performance of the above indicated work <br />