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Advanced c CHAIN OF CUSTODY RECORD <br /> - Date o--230 134age --L of____!_ <br /> --- ," GeoEnvironmental, Inc. <br /> 837 Shaw Road Stockton, California-95215-(209)467-1006- Fax (209)467-1118 <br /> Client <br /> Project Manager <br /> ��� � i�C�LJr� t MM C• � �r Tests Required <br /> Phone Number <br /> Sample : (Signature) Invoice: <br /> Project Name c - AG> Client E. <br /> Gfew� s MeAf ke-+ ❑ <br /> Sa a Type <br /> Sample Location Date Time Water Solid No. of /R Notes <br /> Number Description comp. (arab. Air Conts. 1` <br /> MWI/fl��.�tf3Z 40 ; oz. oy <br /> kw-L/t01g0 IvlgoZ to ; <br /> i <br /> y; natur Recel so by. ignatura DaWrime <br /> 10.1002 Z a2 oO <br /> �nquished by: (Signature) Received by. (Signature) Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) Data/Time <br /> Dispatched by: (Signature) Datemme Recelv*31or LffibGratory by: Date rime <br /> Method of Shipment: Laboratory Name <br /> Cc,I Ove-ro t - c u54 z <br /> Special Instructions:/� t `` i I hereby authorize the parlormance of the above Indicated work. <br />