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MIMI MM M mm <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. <br /> Date X-3L-�*C5 . Page of <br /> 837 Shaw Road- Stockton, California-95215 (209)467-1006-Fax (209)467-1118 <br /> Client '0 Project Manager Tests Required <br /> Phone Number <br /> Samplers: <br /> (signature) Invoice: <br /> AGE <br /> Project Name Q Client <br /> Sample Type <br /> Sample Location Date Time5olid No. of Notes <br /> Water <br /> Number Description I Air Conts. <br /> Comp. Grab. <br /> kJ Ll <br /> Y, y <br /> C' ob <br /> X <br /> V <br /> X <br /> Relinqdp+w�d by: (tignature) Received by: (Signature) Date/Time <br /> '",I Q <br /> Relinquished by: (Signature) Received by: (Signature) Dat*rrime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) Daterrime <br /> Dispatched by: (Signature) DatelTime Received for Laboratory by: Da a Ime <br /> Z. <br /> Method of Shipment; Laboratory N <br /> Special instructions, I hereby authorize the performance of the above indicated work. <br />