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Advanced <br /> CHAINOFC STODY RECORD <br /> GeoEnvxronmental, Inc. Date P ge _j� of <br /> 837 Shaw Road - Stockton, California 95215- (209) 467-1006 Fax j209)467 1118 <br /> Client Project Manager Tests Required <br /> l <br /> r P ne Number <br /> 1 � <br /> r&AZ7t0Q O Sam p (Si ure) Invoice <br /> Project Name , AGE <br /> t W,t ❑ <br /> t <br /> lClient ❑ <br /> Sample Location Sample"hype No of r <br /> Number Description Date Time Water Air Solid Cants Nates <br /> Comp Grab +j <br /> Low <br /> 'Pell <br /> " NIcJn(S191nal-I-) <br /> a 7e+nq s eceive y ignature D to/Time <br /> LRelinquishReceived by (Signature) Dateffime <br /> ehnquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/TimeReceived for Laboratory by 3 T Date Imo <br /> Method of Shipment Lffbarkt py, Wee ( a <br /> t'Z <br /> Special instructions V0,01 0&(] I MEI'AIS� OTfIER 1 hereby auth r e71' <br /> (p mance of the above Indicated work <br /> ICIJt° f PRESERVATION / j !_HEAD SPACE ABSENT` CONT'AINERS� <br /> DECHLORINATED IN LAS PRESEIWED IN L <br /> f .G..--1 t & <br />