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Advanced CHAIN OF CUSTODY RECORD <br /> --- GeoEnvironmental, Inc. Date -22- 19 Page - — Of4— <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 I 0 3(4 a 3 of (9 U <br /> ClientS Project Manager // ,! le <br /> t V-41C i V1, C, P Lr#►�- Tests Required <br /> Phone Number 4 <br /> W, 7— C <br /> V 7 Samplers (Signature) 0 Invoice <br /> Project Name4AGE)< <br /> Ghent ❑ <br /> Sample Type <br /> Sample Location Date Time No of r ' <br /> Number Description Water Air Solid Conts <br /> y s <br /> L ! yv Comp Grab <br /> X <br /> A z 12 <br /> + IAV- � /-?L- <br /> 4- <br /> Re <br /> -Z - <br /> shedby P alure Hoc I y igrratute <br /> Sr� DatelTime <br /> pys d <br /> Relinquished by (Signature) ved b a <br /> Y �Sr 9 lure) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date(Time <br /> Dispatched by (Signature) DatelTime Received for Laboratory by DalelTime <br /> Method of Shipment eov '� CCEi✓� Laboratory Name ' <br /> 7:7— *- t Q,t+ !M C <br /> Special Instructions I hereby authorize the periormence of the above Endiceled work <br />