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CHAIN OF CUSTODY'RECORD <br /> Advanced rte ( -0 O Date12-15 Page __(_ of <br /> --= GeoEnvironmental, Inc <br /> •, 837 Shaw Road - Stockton California- 95215- (209)467 1006- Fax (209) 467-1118 <br /> Project Manager <br /> Client �i Tests Required <br /> C,—I(.e/A"* <br /> a� <br /> Samplers (Signature) Invoice <br /> AGE T< <br /> Project Name l Client ❑ <br /> Sample Type No of / <br /> Sample Location Date Time Water Solid °� Al [, Notes <br /> Number Description Comp Grab Air Conts v <br /> 411:(:'2 JAI 3111,0 j 2 r4- 12 ! Z r <br /> AWL <br /> A7- <br /> W <br /> M� ?-C� M� � �c�l�, i In <br /> Nt�� 'Z� 1036 x x <br /> IV 12L F <br /> eceive y ignature D te(Ttme <br /> e�11�el) � ature) 1 <br /> Relinquished by (Signature) Received by (Signature) ! Datal7i e <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysts (Signature) �"� Date/Time <br /> Date/Time Receiv d r l orato b l ate(Time <br /> Dispatched by (Signature) <br /> Method of Shipment Laboratory Name s <br /> r �C <br /> Special Instructions <br /> A, I hereby authorize the performance of the above indicated work <br /> Y <br />