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Advanced <br /> CHAIN OF CUSTODY RECORD <br /> 72GeoEnvironmental, Inc. <br /> Date C-j Page c3f <br /> 837 Shaw Road- Stockton, California 95215 - (209)467-1006 - Fax(209)467-1118 <br /> Client Pro ,I Manager Tests Required <br /> _VA CLLP_k�cxi- <br />- horse Nugiber <br /> '16_7~10a(-- <br /> Samplers (Signature) Invoice <br /> Protect Name � � � s /� AGE <br /> C�� � � <br /> Sample Location Date Time Comp Grafi Water Notes <br /> Client ❑ <br /> Type Solid No at �y <br /> Number Description Air Conts ` <br /> T- C tk3 x 1C X <br /> gift, t"rug- <br /> X x <br /> /730 <br /> e i uis a y ( nature) (Signature) Dais/Time <br /> AW mquished by (Signature) Received by (Signature) Date(Time <br /> - Relanqutshed by (Signature) Received by Mobile Laboratory for field analysis (Signature) S7> AJ Date/Time <br /> Dispatched by (Signature) DatelTima Received for Laboratory by ` DatelTime <br /> Method of Shipment Laboratory N me / <br /> Special instructions 1� --•. t her authorize the performtrnrie of the above indicated work <br /> AJ <br /> --- �� <br />