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�L Advanced `t��� CHAIN OF CUSTODY IRCORD <br /> GeoEnvironmental, Inc. Date 10111 q Page -L— of <br /> of Northern California <br /> 1803 West March Lane Suite A Stockton California-95207 (209)956-0264-Fax(209)956-0700 <br /> Client r Project Manager <br /> Tests Required <br /> 'L 0:�$ 1,A 6tz A D Pone Number <br /> q5LO 7.1,09 <br /> L <br /> C-A Samplers (Signature) invoice <br /> Project Name AGE <br /> PC,L Client ❑ <br /> Sample Location Sample Type No of <br /> Number Description Date Time Water Air Solid Conts Notes <br /> Comp <br /> lYf41�1�Pil� �\II <br /> 'Stic,A <br /> t x c,, x t x V '< <br /> I" ll IvoAly <br /> l+v Z ? Lo h R 6nL �- <br /> 5,444 - 3 <br /> elinguis ed by (Sinature) ecoive y (Signature) Date/Time <br /> STagNDAQ{J) 013,1ilj',� 45;rr) <br /> Relinquished by (Signature) Re v by ( ignalure) �/— �_ Daterrtme <br /> Relinquished by (Signature) Recetve y Mobile [laboratory for field analysis (Signature) Datetrime <br /> Dispatched by (Signature) Date/Time Received for Laboratory by DalelTime <br /> Method of Shipment Labolratory Name <br /> 1 <br /> Special Instructions I hereby authorize the performance of the above Indicated work <br />