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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Dace b :;?-3k Page --�L of <br /> 637 Shaw Road - Stockton,California-95215- (209)467-1006- Fax (209)467-1118 <br /> Client �} l - Project Manager Tests Required <br /> rt�-t- C�I esr— <br /> Phone N rT <br /> Samplers (Signature) �� Invoice <br /> Project Name ,� ,� AGE <br /> K4,i tA.LJC,7 t&r CCd- L id ` Client ❑ <br /> Sample Location Sample Type (� <br /> No of <br /> Number Description Date Time Water Air Solid Conis Notes <br /> Comp (arab � <br /> -7cQ'` i gyj <br /> B 7-S pjlf-_7 � <br /> ,'A <br /> WVJ <br /> e inqum e t lure ecetve y -pig nature) Oat frame <br /> Relinquished by (Signature) Received by (Signature) Date/Time <br /> Relinquished by {Signature) Received by Mobile Laboratory for field analysts Ignature) DatefTtms <br /> Dispatched by (Signature) DatefTtme R cetved or Lab r tory at imo <br /> Method of Shipment Laboratory Na e <br /> Special Instructions l� - 1 � ��� t hereby authorize the performance of the above Indicated work <br />