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l Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc, pate Page z of -Z-- " <br /> 837 Shaw Road- Stockton,California-95215-(209)467-1006- Fax (209) 467-1118 <br /> ClientProsect Manager <br /> � 1Tests Required <br /> 0 � <br /> Phone Number <br /> Samplers (Signature) Invoice- <br /> Project [ <br /> Prosect Name AGE <br /> / V Client ❑ <br /> v <br /> Sample Location Sample-Type No of �+� <br /> Number Description pate Time Water Air SolidNo (� Notes <br /> Comp (crab <br /> 1.3%O <br /> s <br /> Bolinqui a tore ece va y gnature) DatelTi e <br /> Relinqu ed by f"naturer Received by (Signature) , Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Qaterrims <br /> Dispatched by (Signature) Date[Time ece ved for Laboratory by Date/Time <br /> I <br /> Method of Shipment Laboratory Name <br /> p <br /> Special Instructions I hereby authorize the performance of the ab ve Indicated work <br />