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( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmentai, Inc Date Page L of <br /> 837 Shaw Road- Stockton California- 95215 - (209)467-1006 - Fax (209) 467-1118 1 0 ^ 0 1 1--1 <br /> Client Project Mana <br /> e!,.,� � Tests Required <br /> bone kumber <br /> cc o(0 <br /> Samplers (Signature) � �• Invoice <br /> Project Name`� � �� ��` r,y " Client <br /> Sample Location Sample Type No of .0 <br /> Number Description Date Time Water Air Solid Conts � Notes <br /> Comp I Grab y <br /> . :lt toc��c .M�nr i»A t 0101 04 oqo X K- <br /> nN� <br /> xk"�I . Ut 7t> toL �o <br /> i t Ju'�.W LZ ) <br /> el a y iVelure eceive y ignature Date/Time <br /> tL <br /> Rein uishe by (Signature Received by (Signature) <br /> DatalTime <br /> Relinquished by {Signature) Received by Mobile Laboratory for field analysis (Signature) Date[Time <br /> Dispatched by (Signature) Dote/Time Received for Laboratory byt����'///� Date/ri e <br /> / <br /> Method of Shipment cicx( 0\�.6�sc rqc <br /> p Laborato "ma I y J <br /> Special Instructions f =( L I her authorize the performance of th ova indicated work <br />