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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvzronmental Inc. Date Page Of <br /> -1 <br /> of Nnnhen: California <br /> 1803 West March Lane,Suite A-Stockton.California-95247- 209 956-0264-Fax r <br /> ( ) (249)956-0700 <br /> Client C�htr � Project Manager <br /> JQ- Tests Required <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> Project Name � AGS [� <br /> S ►� �r o p F�2,�-y S"""'� t.4_)d4Q ,� Li ! Client <br /> Number Description ❑ <br /> Sample Location Sample Type / <br /> Date Time Water Solid t No.of / Notes <br /> Air Conts. �� <br /> Comp. Grab. <br /> V- ( X I <br /> r <br /> i <br /> e inquts a y: (Signature) ecelved y: ( r ature --� Dale/Time <br /> Relinquished by: (Signature) Received y: (Signature Dale/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature). �o�/L� /ate' s•Ya f'"�:�r �t e✓ Date/Time <br /> Dispatched by: (Signature) Date/limoReceived for Laboratory by: j <br /> DatelTime <br /> Method of Shi ent. J/1 X1((11 Laboratory Name <br /> MC <br /> Special Instructions: ti. t i�t�f^1 I hereby authorize the performance of the above indicated work. 1 <br /> u IT.101'1 PPROPRIATE <br /> W r <br />