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Advanced 1� CHAIN OF CUSTODY RECORD <br /> ---- GeoEnvironmental, Inc. Date Page o� <br /> 4005 North Wilson Way-Stockton,Calitomla-95205-(209)467-1006-Fax(209)467-1118 <br /> Client Project Manager <br /> Kev?ti M y K' Tests Required <br /> Phone Number 1 <br /> zoq- q6 T- 1006 ,�44 <br /> Samplers (Signature) Invoice. <br /> Project Name t. !r/1,G r AG E C' <br /> j far!l e�5 DaY` -� It/'i�`e ���� �� �`� Client L]- I <br /> Sample Location Sample Type No of a <br /> Number Description Date Time Water Air Solid Conts � Notes <br /> Comp Grab rC <br /> 55 -30 <br /> 8 5' -3! <br /> � 6 -), 5 <br /> B 6 -30 - 11 1V 1 i <br /> e inquis e � ignature e e ve re �'� 91 Dale/Trme � <br /> Relinquished by (Signature) ceived I tsignature) I 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 /> CA i <br /> Special Instructions I hereby authorize the <br /> L Aperformance of the above indicated work <br /> til• l� r fisun iiiiiiiii illi i <br />