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1— ml� �M _M1 M <br /> j Advanced CHAIN PF CUSTODY RECO D <br /> _- GeoEnvironmental Inc. Date PageOf <br /> 837 Shaw Road- Stockton, California- 95215- (209)467-1006- Fax (209)467-1118 <br /> Client Pro' Mina or <br /> lTests Required <br /> �2 <br /> )Rhoneumber <br /> lers- ignature) Invoice: <br /> ProjectName AGE ET' <br /> Client ❑ <br /> f <br /> Sample Location Date Time Sample Type No. of <br /> Number Description Water Air Solid Conts Notes <br /> Comp. Grab. <br /> e i s ature Received by: (Signature) to im <br /> 1� � <br /> Relinquish d by: (Sign t e) Received by: (Signature) Ddleffirne <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) DatelTime <br /> sy <br /> A 4T7 <br /> Dispatched by: (Signature) DateJTirno Received for Laboratory by: Dat Rime <br /> Method of Shipment: Laborat dame <br /> (I Q 11 <br /> Special Instructions: I hereb a Chari the perlormance of the above indicated work. <br />