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Advanced CHAIN OF CUSTODY RECORD <br /> --- ," GeoEnvironmental, Inc. <br /> S 1 ��� Date 03- -98 Page of� <br /> s <br /> 4005 North Wilson Way-Stockton,California-55205-(209)467-1006 Fax(209)467-1118 <br /> Client Project Manager Tests Required <br /> c , <br /> e <br /> Phone Number <br /> 2 ^ 4/b - 100 <br /> Samplers: (Signature) Invoice: <br /> Project Name AGE .A( <br /> Ye.da ra , Client Q <br /> Sample Location Sample Type <br /> Date Time No.of <br /> Number Description Water Solid , Notes <br /> Comp. Grab. Air Conts. <br /> P aagE bo�;� <br /> P � � t�lit <br /> ."c rI% !r sAMP c X <br /> >:s-+ X <br /> Roof— ariAaw I SAMpk <br /> FELC+ PAC X <br /> Poe� +rl+�yik► ,�MP1e- , X <br /> -Z CCq <br /> P —Z5 PA <br /> obE bacifvoj 1 Ishmpit 1 <br /> u1 COKbec"Inj* I , SAAf� <br /> P( O <br /> I Moat; bot•Inoj' t� SAffl%pk, 69w <br /> R - II <br /> ngws <br /> %iiiig-nature) :-Scilvuey: na re <br /> S-T+N.Q Date/Time <br /> -cA- g 3:J0 <br /> Relinquished by: (Signature) Received by: (Signature) Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) Date/Time <br /> Dispatched by:(Signature) Date/Time or Laborato y: _ Date/Time <br /> Method of Shipment: Laboratory Name <br /> Special Instructions: I hereby authorize he performance of the above indicated work. <br />