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( Advanced CHAIN OF CUSTODY RECORD <br /> .:.. <br /> GeoEnvironmental Inc. Date '` Page of Z <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> Client <br /> Project Manager Tests Required <br /> Phone Number <br /> 00 6 <br /> Samplers: (Signature) Invoice: <br /> �'Qlect Name ` ,� I( T � <br /> I � ' v4 (l+y' I (^c.I` r r Sq 1 ` ,is?/L'IM i�(✓t�c 1�1.c�/�` `, �, AGE Co <br /> Client ❑ <br /> Sample Location Sample Type a� <br /> Number Description Date Time <br /> Water Solid No. of ``� "* Notes <br /> ^� Com Grab. Air Conts. <br /> Io <br /> ehngws e <br /> Y: ( ignature) <br /> Vv' eceive y: ignature <br /> elinquished b 9 I c��(7��l�l y� �)) - •j Date/Time ^ <br /> Y (Signature) <br /> eceived by: (Signature) Date/Time <br /> Relinquished by; (Signature) <br /> Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) <br /> Date/Time Received for Laboratory by: Date/Time <br /> Method of Shipment: <br /> Laboratory Name <br /> Special Instructions: /, I C�t�; <br /> I hereby authorize the performance of the above indicated work. <br />