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l <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date r Page --�— of <br /> — <br /> 837 Shaw Road - Stockton, California-95215- (209) 467-1006 - Fax (209) 467-1118 <br /> Clienti Project Manager <br /> Tests Required <br /> Phone Number <br /> LZ.Qfi 4 61- icc�{;, � <br /> Samplers: (Signature), Invoice: <br /> Project Name , ` <br /> W 'S Icy e� _ _ ( tom - �, `�� Acs <br /> '�- � Client <br /> Sample Type <br /> Sample Location No. of <br /> Number Description Date Time Water Air Scud No. <br /> Notes <br /> Comp. Grab. <br /> (0 f ►3 <br /> Ie <br /> f 5-- ( 6 <br /> tai - w g l W4. <br /> W2_ - '�;` 04— C� <br /> 13"L� IO� -2 , ta' <br /> ee(i quis a y: ( ignatureReceived y: ignature Date/Time <br /> 4- 1116 64Z134�) <br /> Relin shed by: (Signature) Received by: (Signature) Da errime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> S T A7 <br /> Dispatched b (Signature) Date/Time Received for Laboratory by: <br /> Method of Shipment: ASI �� Labors y Name <br /> > <br /> Special Instructions: I hereby authorize the performance of the above Indicated work. <br />