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( Advanced CHAIN OF CUSTOD RECORD <br /> ---_ <br /> GeoEnvironmental Inc. Date Page of <br /> 837 Shaw Road- Stockton, California -95215 -(209) 467-1006- Fax (209)467-1118 Q _ (" <br /> Client fi Project 1janager Tests Required <br /> P n Number <br /> f <br /> S iers: (Signature) Invoice: <br /> Project Name ( AGE Q <br /> � OL „�,t)C, h Client ❑ <br /> Sample Type f <br /> Sample Location Date Time No. of <br /> Number Description Water Air Solid Conts. Notes <br /> Comp. (arab. <br /> 4l-- Z13t D ' <br /> ILot3 <br /> e mquia i a raReceived y: ignata to me <br /> Relinquished y: (Sip ature) Received by: (Signature) AIM <br /> Signature) <br /> Datelr me <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory y: oate/Time <br /> • i—I'7A3 Ict �3G <br /> Method of Shipment: Laboralo ame <br /> P fir <br /> Special Instructions: I hereby a t rize th a ormance of the above Indicated work. <br />