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( Advanced <br /> CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date �rZ7�Z Page of 3 <br /> 837 Shaw Road- Stockton,California-95215- (209)467-1006- Fax (209)467-1118 <br /> ClientProj'aqt Mana er <br /> Tests Required <br /> Pho pp�JNucmlaer <br /> Com` <br /> Samplers: (Signature) Invoice: <br /> Project Name � EL �t) r-V c S. CI ent <br /> Sample Type (y�J <br /> Sample Location Date Time Water SolidNo. of Notes <br /> Number Description Comp. Grab. Air Conts. <br /> 4 I <br /> 2 IAV�1' -Z7o� l =ZZf1cZ <br /> - � JAt s�- <br /> e in a y: natu ecerve y: ignature Datefrime <br /> Relin wished by: (Signature) Received by:(Signature) r Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) DatelTime Received for Laboratory by: Date/Time _ <br /> Method of ShNL- <br /> Special <br /> nt: Labo atory Name <br /> �U <br /> Instructions:" I hereby authorize the performance Lh, Lp,, dicated work. <br />