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( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date C�� j j _ Page <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> Client Project Manager <br /> T m Cc-,ellar <br /> Tests Required <br /> Phone Number <br /> Samplers; (Signature) �� 6 Invoice: <br /> Project Name e .4 � AGE <br /> r..c-, l <br /> � 5 rtef 0 Client <br /> Gre ❑ <br /> Sample Location Sample Type ! <br /> No <br /> Date Time Water Solid . of <br /> Number Description V Notes <br /> Comp. Grab. Air Conts, Gj <br /> t^'Ik'1��4'ztG C 1C� fs >S— X i ^ X IX U1tr9 4 <br /> =+Mi�•t-.IC�,Ltc �G.�t C�k I`t 3 S � x � .�( <br /> Xz�; <br /> ( ignature) eceive y: ignature Dte/Time <br /> / 6w(Cil l S G <br /> Relinquished by: (Signature) Received by. (Signature) DatefTime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) DateMme <br /> Dispatched by: (Signature) Date/Time Raceiv fa aboral y b Date/Tim <br /> S <br /> Method of Shipment: Laboratory Name <br /> Special Instructions: I hereby aut orize the performance of the above Indicated work. <br />