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�B <br /> Advanced CHAIN OF CUSTODY RECORD , <br /> —_ Date Page ! of <br /> -=- GeoEnvironmental, Inc. <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> 10510 x ME 3 <br /> Clientjec Manager � <br /> �' ProIC L er is Required <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> Project Name AGE Wf <br /> Client ❑ <br /> Sample Location <br /> Sample Type <br /> Solid No. of Notes <br /> Date Time Water <br /> Number Description Comp. Grab. Air Conts. <br /> J <br /> 65 �.� , fro ✓ �C � � 85903 '� <br /> Rel r u ed y: (Sign j ece ve y: =gnat e) 7 Date(Tlme <br /> ,Geste uGCv 7 lQ: Z <br /> Relin ui: ed y: (Signature) Jlocleived by: (Sign ure) 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: t Date/Time <br /> Method of Shipment: lGertfe k Laboratory N e r A <br /> I�.0 V <br /> Special Instructions: `a&G Mr r��s aI hereby authorize he performance of the above indicated work. <br /> V THEn <br /> HEAD SPAGLABSEW CONYAMEKL3L <br />