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1 <br /> i • • <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. <br /> Date �14 Page of <br /> ' 837 Shaw Road - Stockton,California- 95215- (209)467-1006- Fax (209)467-1118 0 Ct - (� <br /> Client ''� [� Project Manager Tests Required <br /> nn� <br /> Phone Number <br /> z (,7- cr <br /> Samplers (Signature) Invoice <br /> Project Name v� 0 AGE ,0 <br /> � � Client ❑ <br /> Sample Location Sample Type <br /> Number Description Date Time Waterr Solid ContsNo of � � / Nous <br /> Comp Grab <br /> ' — CIBC +i 1/U•'�� �i -Z-Z1 3 <br /> vVw IAA'W` Zai K n <br /> UW-'�T YV\\A/ 3 <br /> 3" <br /> i <br /> e m i e y ignww��� lt(cW <br /> acetve y ignature) atal7ime <br /> Relinquished by (Signature) Received by (Signature) DatefTune <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Dateltime <br /> Dispatched by (Signature) Date/Time Received for Laboratory by1 Date/Time <br /> 7-o' l j <br /> Method of Shipments Lab ory Name <br /> CCJ <br /> Special Instructions I I hereby asihorixe the performance of above ind cated work <br />