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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc pate jt'( Page IL of <br /> 837 Shaw Road-Stockton, California-95215 - (209)467-1006- Fax (209)467-1118 7 - 07 / <br /> Client cul _ Project Manager Tests Required <br /> Phone Num <br /> C� L ?- <br /> Samplers (Signature) invoice <br /> Project Name AGE4 <br /> (�} JCA4, Client ❑ <br /> 4 C'L-C1�if� r1 <br /> Sample Location Date Time Water Sample Type Solid No of Notes Description Comp Grab Air Conte \ <br /> I �Ul �i kb <br /> �O off- ti} <br /> j t )Rojim � <br /> ws e -y net r Received y (Signature) DatelTime <br /> Relinquished by (Signature) Received by (Signature} <br /> �1 _ Date 17-05 <br /> e 5G <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time lReceived for Laboratory by ^7 Date/Time <br /> l 52211, 14- <br /> Method <br /> 4-Method of Shipment LabolvIry Name e_ <br /> Luervkf C <br /> Special Instructions I hereby authorize the performance of the above Indicated work <br /> G <br />