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L� Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmentai, Inc. Date Page of L_- <br /> of Northern California <br /> 1803 West March Lane,Suite A-Stockton, California-95207-(209)956-0264-Fax(209)956-0700 <br /> Client �S5 - Project Mana er Tests Required <br /> I () 1�.+ ✓&Z k' W, <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> Project Name f( , C ' `� �/y AGE <br /> Client ❑ <br /> Sample Location Sample Type <br /> Date Time Sample <br /> No. of <br /> Number Description Water Air Conts. Notes <br /> Comp. Grab. <br /> WAD <br /> 'a X <br /> e mqui h d by:: ( ignaturM e y- ( ign re A-,` Date/Time <br /> Relinquished by: (Signature) eceived 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 <br /> Special Instructions: I hereby authorize the perfo mance of the above Indicated work. <br /> t �5 ti <br /> sr <br />