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( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmenal, Inc. <br /> Date E Page f- <br /> 4005 North Wilson Way Stockton,California-95205 (209)467 1006-Fax(209)467-1118 <br /> Client ` Project Manager <br /> < Tests Required <br /> Pbmbar <br /> 7- 0of, <br /> Sam p (Signature) Invoice <br /> Project Name �" F—y-- f/� AGS <br /> Client <br />� Sample Location Sample Type h <br /> Number Description <br /> Date Time Water Air ConSolid No st Notes <br /> comp Grab <br /> KJ�/or,-/ / I kI <br /> -00 Ilk X <br /> Li�� 4 <br /> I I <br /> e mqw e ( ign lure aceive y ignature ate me <br /> Refirliquisfied by Signature) Received by (Signature) Date/Tlme <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) pateMme cei d for Labor to y by / ata/Time <br /> Method of Shipment ` oc) r C <br /> P Laboratory me <br /> Special lnstructrons I hereby aT ho ze the p ormanc of the above Indicated work l <br /> r <br />