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{ Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. ` <br /> Date �' Page of �Z . <br /> 837 Shaw Road- Stockton, California-85215- (20$)467-1006- Fax (20$)467-1118 <br /> Client Pro' Manager <br /> p t AJ Tests Required <br /> Phone Number <br /> 6e) 6 <br /> Samp r& (Signature) <br /> Invoice: <br /> Project Name t� a1 AGEJLI <br /> , <br /> Client E3Sample Location Sample Type 3� V <br /> Number Description Date Time Water Solid No. of Q A. � <br /> Comp. Grab. Air Conts. Notes <br /> I <br /> R31AUished by: tgnature stews y: ignature <br /> *Datefflme <br /> Relinquished by: (Signature) Received by: (Signature) <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) <br /> DatalTime <br /> Dispatched by: (Signature) <br /> ` <br /> g j DatelTlme Received for Laboratory by: <br /> � Date/Tlme <br /> Method of Shipment: <br /> P L or to <br /> Special Instructions: ° <br /> I here authorize the performance of the above Indicated work. <br /> i <br />