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j Advanced CHAIN OF CUSTODY RECORD <br /> --- GeoEnvironmental, Inc. Date Pageof <br /> 837 Shaw Road - Stockton, California- 95215 - (209) 467-1006- Fax (209) 467-1118 <br /> Client Project Man a <br /> glib' LTests Required <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> Project Name � AGE,K <br /> Client ❑ <br /> Sample Location Sample Typepate Time N° of <br /> Comp. <br /> Number Description Water Air Solid Conts.. Notes <br /> Grab. <br /> 10 d Z- <br /> Relinquished a y: ignatur ) Receivedy: (Signature) / Oate/Time <br /> Relinquished by: (Signature) Received by: (Signature) Date/time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signet Dato[Ti <br /> 7f <br /> Dispatched by: (Signature) Date/Time Aeceive IW Lab t b : at r e <br /> ' <br /> Method of Shipment: Laboratory me <br /> Special Instructions: I hereby authorize the performance of the above indicated work. <br />