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Advanced `� C� CHAIN OF CUSTODY RECORD <br /> �?..::. GeoEnvironmental, Inc. Date y/.� ,��Page —� of--,Z- <br /> of Northern California <br /> 1803 West March Lane, Suite A-Stockton, California-95207-(209)956-0264-Fax(209)956-0700 <br /> ClientProject Manager <br /> V- —�r� Tests Required <br /> Phone Number <br /> Sam (Signature) <br /> p �R Invoice: <br /> Samplers: <br /> y(/.'/JN/IV /C,N ,�op ���j�A / AGE [I� <br /> Project Name �p�t�71LE'� %Fn! ( 0/3 <br /> Client ❑ <br /> Sample Location Sample Type No.of ) F <br /> Number Description Date Time Water Air Solid Conts. ( Notes <br /> Comp. Grab. <br /> Ix / <br /> 57- <br /> oa'A�sir <br /> Ocf - <br /> $4v+n Oieie•Ct Wg <br /> cot( /4- <br /> 1FH- NS o;c- <br /> rt <br /> („( ?;.4- LJ ucI(er- 'TAS47 <br /> e e by: (S nature � e ei ignature f Date/Time <br /> 9 a0 <br /> Relinquis y: (Signature) Received by: (Signature ) Jr Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory f field analysis: (Signature) F Dale/Tlme <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: DalerTime <br /> Method of Shipment: Laboratory Name <br /> Special Instructions: I hereby authorize the performance of the above indicated work. <br />