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! Advanced - /3 -c6 CHAIN OF CUSTODY RECORD• <br /> 1 - Date Z7 �'� Page —7--of---ZGeoEnvironmental, Inc. <br /> 837 Shaw Road - Stockton,California-95275- (209)467-1006- Fax (209)467-1118 <br /> Clientty e 5 ProJW Manage Tests Required <br /> Phonfii Number <br /> (me,) <br /> Sam : Si natur9) L d Involce: <br /> l gL` K i AGE ❑ <br /> Project Names Lr t5 Client <br /> Sample Location Sample Type P1 <br /> No. of <br /> Number Description Date Time Water Air Solid Conts. v /Q Notes <br /> Comp. Grab. <br /> �y-a z'71 0710 !1` ! 51 ✓ tV/ $- <br /> 9 4741 1t 01 k-1 i <br /> YZ <br /> • <br /> e mq azure ecetve y: ignature Dat Rima <br /> Relin fishmyl <br /> ed by: (Signature) Received by: (Signature) DateRime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) Date/Time <br /> Dispatched by: (Signature) DateRime Received for Labors roryrby, DateRime <br /> Method of Shipment: Laboratory Name <br /> Special Instructions: I hereby authorize he performance of the above Indicated work. <br />