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CHAIN OF CUSTODY RECORD <br /> j Advanced L 2� <br /> --- GeoEnvironmental, Inc. <br /> Date Page Of <br /> 837 Shaw Road Stockton, California-95215- (209)467-1006- Fax (209) 467-1118 ? <br /> Client Proje Manager <br /> ec t scc, e- �, �� Ill Tests Required <br /> Phone Num er 1 <br /> p` <br /> Samplers: (Signature) Invoice: <br /> Project Name AGE.W <br /> 1L <br /> froper� - W Client ❑ <br /> Sample Type <br /> Sample Location Date Time Water Solid No. of Notes <br /> Number Description Comp. Grab. Ai r Conts. <br /> ' q0 <br /> f)--- 10 <br /> -� <br /> e i is ed y: ( i nature) ecerve y: (Signature) Date/Time <br /> Reli quished by: (Signat e) Received by: (Signature) Date/Tima <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Laborator y,—(,,,k, "J: Data/Time <br /> Method of Shipment: a oratory Name >_ <br /> /� <br /> ck t <br /> Special Instructions: 1 hereby authorize the performance of the above indicated work. <br />