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CHAIN OF CUSTODY RICORD <br /> Advanced <br /> GeoEnvixonmental, Inc <br /> Date (, -}-2- 01. Page I of <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> "!lent Project Manager <br /> T, Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoke <br /> 'reject Name AG E <br /> 'L a ( � �� g� Client p <br /> Sample Location Sample Type No of <br /> Number Description Date Time Water qtr Solid Conts Notes <br /> Comp Grab <br /> I <br /> ere o <br /> 0� <br /> e mquis e y rgnature) Re vs g at re 0 _6-�'" Date/Time <br /> L �!T 1 <br /> Relinquished by (Signature) by ( rgnature) (i Date/Time <br /> 3.a <br /> Relinquished by (Signature) Received by Mobile Laboratory tot field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Received for Laboratory by Date/Time <br /> Method of Shipment Laborator Name <br /> ro k -l IX <br /> Speclal Instructlons l hereby authorize the performance of the above indicated work <br />