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Advanced CHAIN OF CUSTODY RECORD ` <br /> GeoEnvironmental, Inc. Date .- Rage `'� of ;z <br /> 837 Shaw Road-Stockton, California- 95215- (209)467-1006- Fax(209)467-1118 <br /> Client `�� Project Manager <br /> Tests Required <br /> Phone NLlmber <br /> Samp ers: (Signature) lrwoice: <br /> Project Name C AGE,,. <br /> f 111-d1o' E]Client <br /> Sample Location Sample ype <br /> Date Time Water Solid No. of <br /> Number Description {� Notes <br /> Comp. arab. PJr Corns. l� <br /> jo3 d9 o-1 :4t a, 9 <br /> Relinquished { tgnature ece ve <br /> q y: y: gnalure elalTime rr,, <br /> V <br /> Relinquished by: (Signature) Received by: (Signature) Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) lei DaletTime <br /> Dispatched by: (Signature) Date rime Rec r oratory by: <br /> :� DatelTime <br /> Method of Shipment: LaborNe <br /> amatiy2j�kll <br /> �f/►J[ <br /> Special}nstructce* I hereby arize th performance of the above Indicated work. <br /> I <br />