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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Dace z'4' Page of 44 <br /> 837 Shaw Road - Stockton, California- 95215 - (209) 467-1006 - Fax (209)467-1118 [ i o qo -0 <br /> Client Project Manager i { Tests Required <br /> T i tK it eJ(a (- <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> 'i _ ,9 <br /> Project Name -, ,� AGE,tom <br /> Client El�. <br /> Sample Location Date Time Sample Type Solid No of Z` �{� v4 Notes <br /> Number Description camp Grab Air Conts <br /> I r O I L,> / <br /> rC k l,u, � arty :a� 1616, ! �) <br /> r+�+� l I►>t r' �f1fr� r I A <br /> uw �I� t' rak1.IiC11 <br /> e i quis a ignature Receivedy (Signature) Oate/Time <br /> Relinquished by (Signature) Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time J Received for Laboratory by Date/Tim <br /> Method of Shipment Labarry e <br /> 10e-C-4 <br /> Special instructions I heraby uthorize the performance of the above indicated work <br />