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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date Page of at <br /> of Northern California <br /> 1803 West March Lane, Suite A Stockton California-95207 (249)956-0264 Fax(209)956-0700 <br /> Client Project Manager <br /> Tests Required <br /> Ral <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> Project Name yI y <br /> Client ❑ <br /> Sample Location Date Time Sample Type_ Solid No of Notes <br /> q)V Number Description Water Air Conts <br /> Comp Grab <br /> �atGt t <br /> �4 -1� ✓ 1 v <br /> � �, � �s� �`� ✓ I L ✓ o0 <br /> rr <br /> Relinquished y rgnatute a ei e y ipnatur Dat Ttme <br /> Relinquished by (Signature) Received by (Sig lure) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatelTime <br /> Dispatched by (Signature) Date/Time Received for Laboratory by Date/Time <br /> Method of Shipment Laboratory Name <br /> Special Instructions I hereby authorize the performance of the above indicated work <br /> f <br /> NEW <br /> I� I_ '� M I_ IIID <br />