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Advanced 5 1ZC_ CHAIN OF CUSTODY ECORD <br /> GeoEnvironmental Inc. Date z Page '3 of—;!- <br /> of <br /> f ;of Northern California <br /> 1803 West March Lane,Suite A-Stockton, California-95207-(209)956.0264-Fax(209)956-0700 <br /> 1 Project Manager <br /> Client t .�� I Tests Required <br /> w' <br /> Phone Number <br /> 11 C L <br /> Samplers: (Signature) Invoice: <br /> r` AGE W <br /> Project Name Sample Type Client E]NC= Pr o' e, eS - <br /> Sample Location Date Time Water Solid No. of �' Notes <br /> Number Description Comp. Carob. Air Conts. <br /> 1 � 0QR5 <br /> 12 <br /> Is 95 <br /> LA ' ' ' 3',5q 7C <br /> `e inquishe y: (Signature) ecei�.dy. gnature) Date/Time <br /> 7� -1-- '''OGS " 2-5 -� 1 S _0 <br /> Relinquished by: (Signature) Received by: (Signature) DatefTime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) DatetTime <br /> Dispatched by: (Signature) Date/Time ved for Laboratory by: Date/Time <br /> Methodof Shipment: — Laborry Name <br /> LI!r,. e r'i C <br /> Special Instructions: I hereby authorize the performance of the above indicated work. <br />