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l~ Advanced CHAIN OF CUSTOD RECORD <br /> GeoEnvtronmentai, Inc. Date Page aof <br /> 837 Shaw Road-Stockton, California- 95215- (209)467 1006- Fax(209)467-1118 <br /> Client Project Mqna er <br /> Tests Required <br /> AVei pone <br /> Number <br /> 40 <br /> t m ers nature) Invoice, <br /> Project Name AGE E <br /> X Client ❑ <br /> Sample'Type <br /> Sample Location Date Time Water Solid No of �r Notes <br /> Number Description comp Grab I Air Cortts 'ZI <br /> f I q <br /> I e mquis y t re Received by ignature �fJa fame 6� <br /> Relinquished by (Signature) Received by (Signature) t EVaieffirne <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) DatefTime Received for LaboratoDate/Tim <br /> 20 Ai <br /> Method of Shipment Labor Na a � <br /> G <br /> Special Instructions I hereby au ize the performance of the above Indicated work <br /> I <br />