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i <br /> 4 : Advanced CHAIN OF CUSTODY RECORC <br /> l �? r <br /> _-; GeoEnvironmental, Inc. Date r2 Page / of--�c <br /> of Narrhenr Calijontia <br /> 1803 West March Lane, Suite A-Stockton,California-95207-(249)956-0264-Fax(209)956-0700 <br /> Client s '` Project Manager <br /> Tests Required <br /> Phone Number <br /> Samplers: (Signature) ' Invoice: <br /> Project NameDd�_ - AGE <br /> i Client <br /> Sample Location SampleTypeDate Time Water Air Solid Can sf Notes <br /> Number Description <br /> Comp. Grab, <br /> 2Z 1 <br /> r Ix <br /> TZ '5b 1 -- <br /> To-mqur e, by: (Signalute) ec by: ignatu Dale/Time <br /> Ret' ed b iyn e b Signat re) Date/TimeAJ 0�- <br /> 1. elinquished by: (SignatuReceived by bile Laboralo for lield analysis:(Signature) <br /> Date/Time <br /> A <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Date/Time <br /> i <br /> Method of Shipment: laboratory Name <br /> Special instructions: <br /> 1 hereby authorize the performance of the above indicated work. <br />