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Advanced -� 1 CHAIN OF CUSTODY RECORD { <br /> _ - GeoEnvironmental, Inc. Date_�r �'�4�page _� of <br /> o/ Nof7hei-n Calrfofrua <br /> 1803 West March Lane, Suite A Stockton California 95207-(209)9515-0264 Fax(209)956-0700 <br /> Client N Project Manager <br /> K4 v f( 11 M c f� y�� Tests Required <br /> Phone Number <br /> (�Laq) g56 -0)-6L-J <br /> Samplers (Signature) Invoice <br />� Project Name �r�' It f}y� f`S�S <br /> , �tr �� AGE <br /> Client ❑ <br /> Location <br /> Sample Sample Type <br /> F pate Time No of <br /> Number Description Water Air Solid Conts �° Notes <br /> Comp Grab <br /> Bq -4d 3.1316 -Ds17. o- <br /> � a � <br /> e inquis ed y (Si nature) Receive y (Signature) I7aterTime <br /> X¢va� PJM ' <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 Ree ed for Laboratory by <br /> D to ime <br /> Method of Shipment Laboratory Name <br /> Special instructionsw�T J to � � ToTa J l�Qd over w' S a I ` �Q <br /> hereby authorize the performance of the above indicated work <br /> Rl�h l�� <br />