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�" CHAIN OF. CUSTODY RECORD ' <br /> Y ( Advanced t Y <br /> GeoEnvironmental, Inc. <br /> Date �' I �R Page Of" <br /> sir F- <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> Client = Project Manager <br /> --,-,,..-'Jests Required <br /> r >= 4 Phone Number <br /> s , <br /> Samplers: (Signature) <br /> Protect Name �t :.tiAGE� <br /> '.Client <br /> Type <br /> Sample <br /> _ �t . <br /> Sample Location 'No. of Notes <br /> Date Time Water Solid c: <br /> Number Description com crag. Air <br /> p• Conts. <br /> P!, <br /> 4 <br /> P 1: Cyt ,tAy fit h�t�� f yQ . 19 <br /> He mqurs a y: Si nal re eceave y: ignature Date/Time <br /> Relinquished by; ignature) Received by: (Signature) Oate/Tlme <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Oale/Time Received for Laboratory by: <br /> Date/Time - <br /> Method of Shipment: Laboratory Name . <br /> 0 <br /> Special Instructions: I hereby authorize the performance of the above Indicated work. <br />