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w w w �■■ w w w w w w w w ww ww ww w ww ww ww <br /> Ad <br /> vanced C) `Oq CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date 1 Z Page ' of <br /> 837 Shaw Road- Stockton,California-95215 - (209)467-1006- Fax (209)467-1118 <br /> Client Project Manager <br /> - ,k Tests Required <br /> Phone Number <br /> or <br /> Sarnplers (Signature) Irwoice <br /> Project Name {� /l AGEClient ❑ <br /> i <br /> Sampl <br /> Sample Location Date Time Water Solid No of Notes <br /> Number Description Comp Grab Air Comm <br /> �18"-0 AAW rd/ -71�04 CA-,?,k X X I X /X' I <br /> nquis e y eceive y -gnature Date/ria <br /> i� <br /> quished by (Signature) Received by (Signature) DatelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatelTime <br /> Dispatched by (Signature) DatafTime Received for L ra ory b atelTime <br /> Method of Shipment Laboratory Name f <br /> Cot. Laboratory <br /> ,_ <br /> 7-24-10 <br /> Special Instructions /'1 \ I he authorize the performance the above Indicated work <br />