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Advanced CHAIN OF CUSTODY RECORD <br /> jik <br /> GeoEnvironmental, Inc. Date lLle Page of <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> ClientPro'ect Manager Tests Required <br /> mlci�II - <br /> Phone Number <br /> 7-- <br /> -Samplers: (Signature) Invoice: <br /> AGE [21 <br /> Project Name Client ❑ <br /> Type ype <br /> Sample Location SampleNo. of <br /> Number Description Date Time Water I Solid Cants. <br /> Notes <br /> comp. Grab. Air <br /> tqu 2U) <br /> $4 U) 14 <br /> Ll <br /> L. <br /> Relinqu ig at re) Receivea Sy -mignature) Date/Time <br /> S(wrf S Vere, r <br /> 0 <br /> Relinquished by: (Signature) Received by: (Signature) r, )0(111V (AXI 4 bate/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Bate[Time Received for Laboratory by: Date/Time <br /> —0 <br /> Method of Shipment: f Laborator e <br /> Special Instructions; I hereby aut orize he pert mance of the above indicated work. <br />