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[ i t t i i i t t i i i [ i t t i i i <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental Inc. Dace "j-© Page of <br /> 837 Shaw Road-Stockton, California-95215-(209)467-1006- Fax (209) 467-1118 V 6 —o <br /> Client t�� Project Manager Tests Required <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> Project Name ' 5f O `t� �q AGE �' <br /> x Client <br /> Sample Location Sample Type <br /> Date Time Water Solid No. of <br /> Number Description Air Conts. Notes <br /> Comp. Grab. ` <br /> 2— l5 (-,ems 2@ <br /> 4 '201 <br /> tr -1�f 1 35 <br /> P'L-35b n tt f f( '30 ! J X <br /> F-2---65 351 <br /> e inquis ad by: (Signature) eceiva y: ignature <br /> tiles Date/Tim y*� <br /> Zb <br /> Relin ished by: (Signature) Received by: (Signature) f� �I +0 r ` <br /> Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time ReceiV441for Labor ry by: ate/Time <br /> Method of Shipment: Laboratory Name <br /> Special Instructions: 1 hereby authorize the performance of the above indicated work. <br />