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Ad�3anced * S <br /> r °� ` 1 f CHAIN OF CUSTODY RECORD <br /> i GeoEnvironmental, Inc. <br /> �. Date Z"� _�11? Page / of <br /> of Northern Califonua <br /> 1803 West March Lane,Suite A-Stockton, California 95207-(209)956-o264 Fex(209)956.0700 <br /> Client �!.'�_ Project Manager <br /> Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> Project Name AGE j <br /> Client ❑ <br /> Sample Location } Sample Type rr <br /> Number No of <br /> Description Date Time Water Air Solid Conts ^ -- Notes <br /> Comp Grab z_ <br /> rt I I�J 11< <br /> y \fr 9 ( - <br /> e inquis ed by ( 15 a-ture) Fiecerved by (Signature) �J <br /> ( Date/Time <br /> 18Q—uish-qe <br /> d by (Signature) C . <br /> Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) <br /> Date/Time <br /> Di.patched b ' <br /> P y (Signature) Dat Receoved for Laboratory b <br /> r �` ) tefTime <br /> Method of Shipment Laboratory NameAA <br /> ' I <br /> ectal.instructions T f hereby authorize the performance of the above indicated work <br /> (L h"- E1 <br />