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( Advanced CHAIN OF CUSTODY RECORD <br /> ~-- GeoEtivironmental, Inc. Date z� Page /I of <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(208)467-111 a L e� <br /> C (( <br /> Client Project Manager <br /> l�- / Tests Required <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> Project Name �) _ AGE <br /> Client ❑ <br /> Type f <br /> Sample TypNo. o <br /> Sample Location <br /> Dale Time SamWaterpSolid Notes <br /> Number Description comp. crab. Air Conts. <br /> �-7- 12 <br /> el rn is e y rgnature). a we y: gnature —]3 jte Date/Time <br /> Relinquished y: (Signature) Receive by. (Signature) I ' ' r Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Dale/Time <br /> Dispatched by: (Signature) Date/Time received fvr Laboratory by: Date/Time <br /> Method of Shipment: A Labo�ryNa n <br /> VOP,S ar C 1/�1 (/ <br /> %114" A <br /> Special Instructions: rd I hereby nut ooze th parformance of the above Indicated work. <br /> CUUQCO�}DITfDId f�'r�''�r�'�'� 1, 4 <br />