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I� <br /> t Advanced <br /> CHAIN OF CUSTODY RECORD <br /> --= GeoEnv>ironmental Inc Date i� 2 l Page of - <br /> 837 Shaw Road- Stockton, California-95215- (209)467-1006- Fax (209) 467-1118 <br /> ClientProject Manager <br /> C LL, td& <br /> Tests Required <br /> Phone Number <br /> Samplers (Signature) invoice <br /> Project Name AGE <br /> 0 dam- Client ❑ <br /> Sample Location SolidSample Type No of Notes <br /> Number Description Date Time Water Air Cants <br /> Camp Grab <br /> 2— I—A <br /> � t [ <br /> ego <br /> &99 -32— WGv <br /> 43b 2;7,> <br /> Relinqu!pPed by ig Received-by (Signature) Daterrime <br /> Rellliinf?quashed by (Signature) Received by (Signature) A) <br /> Datel7ime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/time <br /> Dispatched by (Signature) Date/time Received for Laboratory by DatelTime <br /> Method of Shrpmen ..! Laboratory Name <br /> [J C <br /> Special Instructions I hereby authorize the performance of the above indicated work <br /> f <br />