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L Advanced CHAIN OF CUSTODY RECORD <br /> " GeoEnvironmental Inc. Date PageOf A <br /> 837 Shaw Road- Stockton, California-95215- (209)467-1006 -Fax (208)467-1118 <br /> Client re's+ cc's in i t Project Manager Tests Required <br /> L:tt 1� <br /> Phone Number <br /> Li - 1 040 <br /> Samplers: nature) x` Irnrolce: <br /> Project-NameAGE J2T- <br /> - + 1 , M C, Client ❑ <br /> Sample Location Same yPe No. ofd 4' <br /> Number Description Date Time Notes <br /> comp. Grab. Air Solid Conts. <br /> MW 1/040792 `I-7-Ci 1-76y \ \ \ <br /> MWt'/ayo7� <br /> AW1/0g0?03 )(4,346 \ \ <br /> Ainquis�ed <br /> y: +gn ura Received y: (Signature) DatelTlme <br /> b Si nature 7-7-c,13Y 9 ) Received by: (Signature) Date/1'ima <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) DatelTime <br /> Dispatched by: (Signature) DatatTime Received or Laborato4 by: Dste/Tlme <br /> /d <br /> Method of Shipment: Laboratory Name <br /> V1��'i 11 l 'r 7eL� <br /> Special Instructions: I her y au orl:e the performance of the above Indicated work. <br />