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j Advanced CHAIN OF CUSTODY RECORD <br /> --- ; <br /> Date Page <br /> GeoEnvironmental, Inc. �j' Z- of <br /> �_ <br /> 837 Shaw Road- Stockton, California-95215 - (209)467-1006- Fax (209) 467-1118 f I f \4_3 <br /> Client � � �� { 4i�rl Project Manager ! 1 <br /> Tests Required <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> Project Name t AGE '� <br /> °LC+ lfi V,,. , v �, �� Client <br /> Sample Location Sample Type No. of <br /> Number Description Date Time Water Air Solid C n s. Notes <br /> Comp. Grab. <br /> p 3 ��' t�15 <br /> 93 - 15' C=i' jL Z� X <br /> 13 LLA 0 4>0 113 � N�Ilk <br /> e inquis a y: (Signature) P—ac—e-N—e y:I S ignature <br /> U� r--- Date/Time <br /> Reli uished by: (Signature) Received by: (Signature) Da (Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) C ' Date/Time <br /> Dispatched by: (Signature) Date/Time _J_Received for Laboratory by �1 Date/T me <br /> Method of Shipment: Lab tory Name <br /> Special Instructions: I hereby authorize the performance of the above indicated work. <br />