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• Advanced EXU CHAIN OF CUSTOD ECORD <br /> GeoEnvlronmental, Inc. Date z - �� a Page z, Of <br /> =" of Nor-them Calrfonua <br /> 1803 West March Lane, Suite A-Stockton, California 95207 (209)956-0264 Fax(209)956-0700 <br /> ClientProject Manager <br /> S N 14,4 U) � M 1- K l' b b v� Tests Required <br /> Phone Number <br /> (-ic,q) 5 56-0� b X v <br /> Samplers (Signature)) Invoice <br /> AGE <br /> Project Name A i^)i'0 5 Qi~ Client <br /> Lj <br /> a� <br /> Sample Location Sample Type No of <br /> Number Description Date Time p Water <br /> Air Solid Conts �� Notes <br /> ComGrab <br /> P 57 -so } H . t C —Eo <br /> Relinquished y (Signat e) Receivedy (Sig-nature) Date/Time <br /> IML-Ir — z 7��q 7/ t 7�oD <br /> Relinquished by (Signature) Receive y ignatur Date/Time <br /> �-- le) 'tJ� <br /> Relinquished by (Signature) Rec ived y obde Laboratory.,for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Tame Received for Laboratory by DatetTtme <br /> f <br /> M Method of Shipment i Laboratory Name <br /> f� Ina wf fit c1 <br /> Special Instructions I hereby authorize the performance of the above indicated work <br />