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( Advanced CHAIN OF CUSTODY RECORD <br /> Date 6 LI <br /> GeoEnvironmental, Inc � Page � of--L <br /> 837 Shaw Road - Stockton California- 95215- (209)467-1006 - Fax(209)467-1118 — 0& <br /> Client Project Manager l Tests Required <br /> Phone Number <br /> plers (Signature) q Invoice <br /> AGE\KProject Name �� ��� ` V Client <br /> Sam <br /> Sample Location Date Time Sample Ty-pe Solid No of Notes <br /> M Number Description Comp Grab Air Conts <br /> ell q is a <br /> Dete(Ttme <br /> azure) ecerve y ignature Date rime <br /> R urs ed by (Signature) Received by (Signature) <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysts (Signature) Date/Time <br /> Dispatched by (Signature) Date rime Received for Laboratory Datefrime <br /> 2 a q <br /> Method of Shipment Lr — A —7 <br /> tory Name <br /> I( � u h by authorize th performance of th above indicated work <br /> Special Instructions <br />