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CHAIN OF CUSTODY RECORD <br /> Advanced <br /> Date 3a Page �L of--L <br /> -_= GeoEnvironmental, Inc D� <br /> I„ 837 Shaw Road Stockton California- 95215- (209)467-1006- Fax (209)467-1118 <br /> Client Project klanager Tests Required <br />� ttitn� <br /> P one N tuber <br /> �a� 67 ©c�6 <br /> Samplers (Signature) Invoice <br /> AGE <br /> Project NameLA�Ak (i D Client <br /> Sample Type �U <br /> Sample Location Date Time Water Solid No of /�/ Notes <br /> Number Description Comp crab Air Conts <br /> -3 X <br /> -ZJQ <br /> C)10 (` <br /> i <br /> e i is yignature Receivedy (Signature) <br /> DatelTim i <br /> Dater e <br /> eiinquished by (Signature) Received by (Signature) <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis {Signature) DatelTime <br /> tA I <br /> DatelTime Recew d r Laboratory by te/Time <br /> Dispatched by (Signature) <br /> I <br /> Laboratory Name <br /> Method of Shipment <br /> I hereby authorize the performance of the above indicated work <br /> Special instructions ) � 1��� F: �� <br />