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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnviron mental, Inc. Date Page of� <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006- Fax(209)467-1118 <br /> Client ¢ S Project Manager <br /> `,t /J C,h Tests Required <br /> Phone Number ✓ <br /> Q r7u✓� / <br /> Samplers: (Signature) Invoice: <br /> Project Name I( ���C>✓%� /u't!'"`- AGE <br /> Client <br /> Sample Location Sample Type No. of S� <br /> Number Description Date Time Water Solid ` Notes <br /> p Comp. Grab. Air COntS. y <br /> r� i <br /> i uis ed y: ( ign� re)/� ec ive y: ( ignature) Date/T e <br /> Relinquished by: (Signature) Received by: (Signature) Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Date/Time <br /> Method of Shipment: Laboratory Name I <br /> Yi <br /> Special Instructions: I hereby authorize the tierformance of the above indicated work. <br /> i <br />