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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. <br /> Date ►i �i _ Page _ of �I <br /> 837 Shaw Road -Stockton, California- 95215- (209)467-1006 - Fax 1209)467-1118 <br /> Client - V er: f s �„ Project Managgr <br /> r Tests Required <br /> Phone Number y _ <br /> T{ J 3 Samplers (Signature) Ls'" " Invoice- <br /> (4, <br /> Project Name AGE ❑ <br /> c :� f{ t� . •" sti Client E] <br /> Sample Location Sample Type No of tit <br /> Number Description Date Time Water Solid Notes <br /> Comp Grab Air Conts <br /> •f5 t yy }}jjjr Ir <br /> , Rd I di <br /> An bt�4&*e-�o __J lit 2 \If PK <br /> k <br /> t +ea <br /> it_ Z. ;�� <br /> f <br /> e inqut§ a y f ignalurejI-Receivedytgnature Date/Time <br /> r , } to - -q <br /> Relinquished by (Signature) Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysts (Signature) ^ � DatelTime <br /> Dispatched by (Signature) Date/Time Received for Laboratory by DatelTims <br /> Method of Shipment $ �� Laboratpry Name <br /> ar J <br /> s � <br /> Special instructions i hereby authorize the performance of the above indicated work <br /> r 1 <br />