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Advanced CHAIN OF CUSTODY RECO-RD <br /> Date Ct _ �7 Page of - <br /> -- GeoEnvironmental, Inc <br /> 837 Shaw Road- Stockton California - 95215 -(209) 467 1005 Fax (209)457-1118 <br /> p7ZIL7 <br /> Mager f Tests Required <br /> B - � <br /> Phone Number <br /> A �tr <br /> Samplers (Signature) invoire <br /> ACE I <br /> 'roject Name qT� tL� 7 � '�-1 y'1. ClientSample n <br /> I <br /> Type <br /> Sample Location Date Time Water Solid No of Notes <br /> Number Description Comp arab Air Cont5 <br /> >l y <br /> 15- 1 d D E a z 90837 <br /> y , r <br /> 90838 s 90841 ( <br /> 51 —3 ' x 90839 90842 <br /> 90840 '� 90843 <br /> a tnqute e ySignature a rve y ign�ture �?! t/late fTune <br /> Relinquished by (Signature) Received by (Signature) j1)�ate(r�ircia <br /> Rahrnqutshed by (Signature) Received by Mobile Laboratory for field aanalysrs (Signalure) DatelTur,e <br /> Dispatched by (Signature) Date)Trme Aacewed for Laboratory by Da1e1Tirne <br /> I aboratory Hama <br /> Method of Shipment <br /> L- GVH .f; C- <br /> Special Instructions 1 hereby authorize the perforrrianca r l ilia agave indicated work <br />