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( _ Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental Inc. Date Page z of <br /> 837 Shaw Road-Stockton,California- 95215-(209)467-1006- Fax(209)467-1118 D /� <br /> ClientProject Manager <br /> gip' Tests Required <br /> Phone Number <br /> t2zleD <br /> Samplers: (Signature) �g Invoice: <br /> Project Name ��,� Mia � Lo� AGE <br /> > Client <br /> Sample Location Sample Type <br /> Number Description Date Time Water Solid No. of �� �y.�� r� Notes <br /> comp. (arab. Air Conts. �{/ ,` <br /> tv <br /> X1— I V1 <br /> 45 <br /> PI—so 1( n rf 5e) `� <br /> �`Z �I r� sc ci CIDf 135 o <br /> Relinquished y: ignature ecerve y: ignature <br /> Relinq fished by: (Signature) Received by: (Signature) <br /> r Date I ime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) Date/Time <br /> t7 <br /> Dispatched by: (Signature) Date/Time Recei t Lebo tory by: Date/Time <br /> Method of Shipment: O—�' v i� ' Laboratory Name Z ` <br /> CA-J, 'Tc <br /> Special Instructions: I hereby authorize the performance of the above indicated work. <br /> ��3 v <br />