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0 <br /> ( Advanced CHAIN OF CUSTODY RECORD <br /> i <br /> GeoEnvironmental, Inc. Date s G`( Page ___L of -- ► <br /> 837 Shaw Road- Stockton, California 95215 - (209) 467-1006- Fax(209) 467-1118 0 <br /> Client U Pro ect Manager 1 <br /> t� Tests Required <br /> Pne N mbe <br /> zho <br /> ��`� 7,< 7- <br /> Samplers (Signature) �. Invoice <br /> Project Name��''�I AGE <br /> Client ❑ <br /> Sample Location Sample Type Date Time NO tat Notes <br /> Number Description Water Air Solid Cents A , <br /> �( Comp Grab V, <br /> '7 ti Woll <br /> XiX A <br /> 124's G X1X IX <br /> e snquis e i azure) Receivedy ignature D taJim /^� <br /> Relinq fished by (Si atufe) Received by (Signature) 6atefrilme <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatefTrme <br /> t r t l <br /> Dispatched by (Signature) Date(Tsme aceivod for Laboratory by `f Date/Ti Te <br /> 1 —) '-1 <br /> Method of Shipment� Labo►ato Name C_(:Z=eL <br /> Special Inatrucbons l i/� / � f I hereby authorize the performance of the above indicated worts <br />