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( Advanced <br /> CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date I Page —1-- of 2- " <br /> 837 Shaw Road- Stockton, California-95215 - (209)467 1006- Pax (209)467-1118 <br /> Client Project Manager <br /> �' ���. �� •� Tests Required <br /> Phone Number <br /> G� t t6 T - I��t� <br /> Samplers (Signature) Invoice <br /> Project Name <br /> j Ak,� ciP �i 'L4 .� y �� �,� ` ` Client E] <br /> AGE <br /> m <br /> Sample Location Sample Type No of ' � <br /> Number Description Date Time _ Water Air Solid Cants , FJotes <br /> Comp Grab <br /> WI 2 O a � <br /> �[eli atureceive r tura Aata tm <br /> R a <br /> t ZI Loo <br /> Relinquished by (Signature) Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Moblie Laboratory for field analysis (Signature) + Datefrime <br /> V <br /> Dispatched by (Signature) DatelTime eived for Laboratory by Date/Time <br /> Method of Shipment Laboratory Name <br /> C <br /> GLi.tom--. 12.E <br /> Special lnstructlons OfI hereby authorize he performance of the above Indicated work <br /> vw- <br />