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w <br /> 8 Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. <br /> Date Page __Z_ of <br /> 837 Shaw Road- Stockton, California- 85215- (209)467 1006- Fax(209)467-1116 <br /> Client ProJV Manager Tests Required <br /> v <br /> Phone Number <br /> "Q^ 6 7 � <br /> Sam p ers (Signa re) Invoice- <br /> Project Q <br /> Project Name !1 Client ❑ <br /> Sample Location Sample Type No of <br /> Number Description Date Time Water Air Solid Conts Notes <br /> Comp Grab <br /> I <br /> —VcvV/o20 l .133S� 1< 3 76895 <br /> VC0 6-B/10170 YO J 76896 <br /> /300 <br /> ti 76897 t <br /> 76898 <br />� I <br /> e mq a e y Lnature ignature Osite/Ti e <br /> oL) <br /> RellrNtAhed bT (919naldre) Received by (Signature) �f /Y n T bate'rTiffle <br /> Relinquishedby (Signature) Received by Mobile Laboratory for field analysis (Signature) //`�j Date[Time <br /> Dispatched by (Signature) Date/Time Received for LaboratoryvdDatelTime <br /> C) <br /> Method of Shipment Laboratoty k <br /> OAL, "C-1-10 j c (1A t L <br /> Special instructions I hot etry autharixe the performance of the above indicated work <br /> e <br />