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( Advanced CHAIN OF CUSTODY RECORD <br /> � <br /> GeoEnvironmental, Inc. Date � �-f— Pa ge of <br /> 4005 North Wilson Way Stockton,California-95205 (209)467-1006-Fax(209)467-1118 <br /> Client I� "e_ Project Managers Tests Required <br /> 1a �'-- <br /> Phone Number <br /> (-SCD-L/("7-1 6n,' <br /> Samplers (Signature) } Invoice <br /> '1 <br /> Protect Name AGE XR Jc���� r-. ,JClient ❑ <br /> Type Typr <br /> Sample Location SampleNo of <br /> Number Description Date Time Water Air Solid Corns Notes <br /> Comp Grab <br /> 0 217 <br /> 3w <br /> DL- <br /> Reli uis a (Signature) eceive y ignature Date/Time <br /> f <br /> qui ed by (SLgnature) Received by (Signature) )' �2 " �pY3 ISI 4kv Date/Time <br /> Retie uished b nature f <br /> q y (Signature)) Recewed by Mobile Laboratory for field analysis {Signature) 6- DatefTtme <br /> do, 54-4, <br /> Dispatched by (Signature) Date/Time Re rved for L oratory by DatelTime <br /> shod of-p0(kK 1U( Labor ory Na } <br /> !I'ri's C/-- �� �r'� A!V�t <br /> Special Instructions I hereby authorize the performance of the above Indicated work <br />