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Advanced CHAIN OF CUSTODY C4 <br /> RQ <br /> GeoEnvironmental, enc. Date Page -of <br /> 937 Shaw Road-Stockton, California 95215-(209)467-1006- Fax(209)467-11181 ` <br /> Client�� r ; r Protect Manager Tests Required <br /> Phone Number <br /> Samplers (Signature) �� Invoice <br /> AGE <br /> `� <br /> Project Name aha Client E] <br /> Sample Location Sample Type No of <br /> Date Time Water Solid Nous <br /> Number Description comp Grab Air ContS <br /> X114 60 -- i <br /> PAVA Kc. <br /> MIN 3b <br /> 5-1 Sy <br /> e inqucs e y ignatu e► Received by (Signature) Dete(Trme <br /> cnquished by (Signa ) Received by (Signature) �* _ Dateffima <br /> `;T.A <br /> Relinquistied by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Data/Time ceived for Laboratory by Date1Ti <br /> 'Y <br /> Method of Shipment Laborato Name <br /> at Gr 'kI <br /> Special Instructions t hereby authorize the performance of the above indicated work <br /> r <br />