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j Advanced CHAIN OF CUSTODY RECORD <br /> --- „' GeoEnvironmental, Inc. rl Date ) Page Z- of�� <br /> 837 Shaw Road- Stockton, California- 95215- (209)467-1006- Fax(209)467-1118 (110 <br /> Client -� r C Project Manager <br /> Cr�e � � <br /> ' Tests Required <br /> Phone Number <br /> Lz y l) <br /> d <br /> Samplers: (Signature) Invoice: <br /> Project Name { r -r�2t �GK 6 t�U� t t M ,tits �Iti �` AGE <br /> Client <br /> Sample Location Sample Type <br /> Date Time Water gaud No. of <br /> Number Description Notes <br /> Comp. Grab. Air Conts. <br /> IctV <br /> '415 1 <br /> 5 <br /> loci- tt tt � ' tole <br /> Relinquished y: (Signature) ecerve y: ignature Date/Ti e <br /> aWAAJ- or) <br /> Reli uished by: (Signature) Received by: (Signature) DatelTime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Received for ora 6 by: JJate/Time it <br /> �' /� ✓ 1t'Lr G�YLe1' �r4 <br /> Method of Shipment: y Laboratory Name 111 <br /> Special Instructions: 1 hereby authorize the performance of the above indicated work. <br />