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Advanced CHAIN OF CUSTODY RECORD <br /> ` Date jU D Page __/_ O# <br /> �,�° � <br /> GeoEnvironmental, Inc. f/ j�' <br /> 837 Shaw Road- Stockton, California-96215-(249)467-1006 Fax (209)467-1118 <br /> Client E,� Project Managel <br /> Tats Required <br /> Phone6� umber r 0 <br /> P <br /> 7(2 <br /> p ars, (Signature) involce• <br /> Project Name AGE( � ! �! <br /> Client ❑ <br /> Sample Location SamplA TypeDate Time - <br /> Number Description Water Air Cents Solid ,l� Notes <br /> Comp Grab <br /> FTT v <br /> IIP.AD 4PACPABSEN ONTAt CERSL—L-1 <br /> DI.CIi OPLI HATED IAI LAB <br /> PRFS RVA'nDN <br /> –fie inq e ( ignur ace ve y gna ure ateTTime <br /> r <br /> Reiliiquishe by (Signature) Received by (Signature) A�Dat*/Tlme <br /> Rehn4ulshed by (Sigriature) Received by Mobile Laboratory for field analysis (Signature) DatelTime <br /> Dispatched by (Signature) Rec i for Loborator by lSMMS - <br /> �;�t'�'&'°� <br /> Method of Shipment Leber to Herpes ___ <br /> Special Instructions I � � I hereby auth the r rmance of the above Indicated work <br />