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( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental Inc Dace-5' 3 4 L f Page -2- of 2- <br /> 837 Shaw Road- Stockton, California- 95215 - (209) 467-1005 -Fax (208)467-1118 <br /> ClientProject Manager <br /> c1 a��� Tests Required <br /> Mone um l �9r <br /> 2pcc Y6 7�-100 �r % <br /> Samplers (Signature) 1(j Invoice <br /> Project Name � AGE <br /> Client <br /> Sample Location Sample TypeDate Time Solid No of N Notes <br /> Number Description Comp Grab <br /> Air Conts <br /> A0-55 a o' 036 -1 K <br /> 2— <br /> '3'3 !� <br /> w s X16 X 'X A X <br /> 61 0�67 <br /> elinquisbeaby JSignature ece ve y ignature atelTi e <br /> 31 1-k e-1 16 36 <br /> Relinquished by—Mignaturer Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) AT DatelTimo <br /> Dispatched by (Signature) Date/Time Racewed for Laboratory b �6�' Date(Time <br /> Method of Shipment La ratory Name <br /> Special Instructions t♦ fr I hereby authorize the performance of the above Indicated work <br />