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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmenW, Inc. Dat 9lE Page ---L of <br /> of Northern California <br /> 1803 West March Lane, Suite A-Stockton,California-95207-(209)956-0264-Fax(209)9560701 <br /> Client L L Project Manager Tests Required <br /> Phone Number <br /> In <br /> Samplers: (Signature) voice: <br /> 50"0 -ffrur� i AGE <br /> Project Named j / Client <br /> Sample Type No of <br /> Sample Location Date Time Water Solid Notes <br /> Number Description Comp. Grab. Air Corrts. <br /> �5-( 1 -[ -9 A:� K i <br /> As-2 <br /> U K <br /> V <br /> Relinquished by: ( ignature) eceive y: ignature �` _�.� �� le(T�me <br /> Date/ <br /> CAI Datelfime re+Cl <br /> Relinquished by: ( ignalure) Received by: (Signature) <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Dateffime <br /> Dispatched by: (Signature) Date(fime Received for Laborator \ DA(efffine /:2�/ <br /> Laboratory Name <br /> Method of Shipment: A) <br /> Special Instructions: I hereby authorize the performance of the above indicated work. <br />