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L Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc Date i ~'��� Page of <br /> of Northenl Cahfonucr <br /> 1803 West March Lane, Suite A Stockton California 95207-(209)956-0264-Fax(209)95&-0700 <br /> ClientProject Manager Tests Required <br /> C <br /> Phone Number <br /> Samplers (Signature) 1 Invoice <br /> Project Name at,- <br /> AGE7- Gek& Client ❑ <br /> Sample Location Sample Type No <br /> Number Description <br /> Date Time Water Air Solid Contst Notes <br /> Comp Grab <br /> I 12-17-96, <br /> � .3 <br /> 2 3 ✓ �t <br /> J <br /> 1e rn i. y (Signature rte <br /> y served by (Signature) <br /> Date/Time <br /> Rehnq she by (Signature) ?Aeceive <br /> by ( ignre!) � � �� l �, J !^ Date(Time <br /> Relinquished by (Signature} Mobile La ratory for held analysis (Signiture) Date/Time <br /> Dispatched by (Signature) Date/lime Receivtid for Laburatory by Date/Time <br /> Method of Ship nt Labor tory Name J <br /> i �L <br /> i LG , <br /> Special Instructions I hereby authorize the performance of the above indicated work <br />