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Advanced CHAIN OF CUSTODY RECORD <br /> -- <br /> GeoEnvironmental, Inc. Date t 2 t t° ° Page of Z <br /> 837 Shaw Road-Stockton, California- 95215- (209)467-1006- Fax (209)467-1116 <br /> ClientPr ct Manager <br /> Ir r <br /> Tests Required <br /> Phone Number <br /> Q C�7 <br /> Samplers: (Signature) Invoice: <br /> AGE R <br /> Project Name LO <br /> CI ent ❑ <br /> Sample Location Date Time Samp a Type Water Solid No. Of Notes <br /> Number Description comp. arae. Air Conts. � <br /> ti rx14j),51vZts, l / <br /> P'W'V 12,1 UC.i ILS :j t f /Q 5 7— <br /> e mqu s e y: (Signature) Received by: ignalura Datefrime <br /> quis d y: (Signature) Received by: (Signature) DatelTima <br /> Relinquished b1c (Signature) Received by Mob its Laboratory for field analysis: (Signature) DatelTima <br /> Dispatched by: {Signature) Date/Time Received to b tory y DatelTime <br /> Method of Shipment: 'Tabor ory no <br /> ca <br /> Vic. Com( <br /> Special Instructions: `� A� I Web ,,authorize the performance of the above Indicated work. <br /> r <br />