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CHAIN OF CUSTODY RECORD <br /> Advanced <br /> GeoEnvironmental, Inc. -z-a I Zu K °� Pageof <br /> : : <br /> 837 Shaw Road Stockton,California- 95215- (209)467-1006- Fax (209) 467-1118 <br /> Client Project Manager Tests Required <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> Project Name �� AGE ;!f-' I Cheat ❑ <br /> Sample Location Date Time Sample Type Solid No. of <br /> Number Description Water Air Conts. 1 Notes <br /> Comp. Grab. <br /> 91 036 <br /> Jim <br /> ,i ti;rSL <br /> P PRA TM <br /> 0;'JOD MW t[ AMAMMATE <br /> au BT <br /> ef`n d by: ( ign t e) Re the y; ignature Date/rims <br /> 1 <br /> r� i •+ <br /> z(2 t bZe <br /> T T-0Re inquished by: Signature Received by: (Signature) Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Datefrime <br /> Method of Shipment: LaboratoryN <br /> Special Instructions: 1 hereby authorize t performance of the above indicated work. <br /> -k si x -l"- /-r-' i /I., <br />