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j <br /> (� Advanced CHAIN OF CUSTODY RECORD <br /> --- GeoEnvironmental, Inc. Date Page _� at. <br /> 637 Shaw Road - Stockton, California - 95215 - (209) 467-1006 - Fax (209) 467-1118 <br /> Client Project anager 'T� <br /> Tests Required <br /> Phone Number <br /> amplers• Signature) Q <br /> Invoice: <br /> Project Name AGE <br /> (C-�IIJILXK& Client ❑ <br /> Sample Location Sample Type <br /> Date Time Water Solid No, of Notes/ <br /> Number Description Air Conts. <br /> Comp. Grab. <br /> 1017 <br /> 0 ._GL -o3 101) k <br /> Mw3 7 o --06-05 <br /> 0 A 63 qqo <br /> w11� J <br /> 1 / 03 --0V-V3 <br /> Rel n u e y ( tig lure) eceive y: 49nature ate/Tim <br /> Relinquishe by: (Signatu ) Received by: (Signature) ��� <br /> Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) ate/Time Re ived for L borat ry by: Date rime <br /> G �% <br /> Method of Shipment: Laboratory Ne <br /> a <br /> Special Instructions: 1 here uthorize the performance of the above indicated work. <br />