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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmentai, Inc. Date �T Page r Of f <br /> of Northern California <br /> 1803 West March Lane, Suite A-Stockton, California-95207-(209)956-0264-Fax(209)956-0700 <br /> Client- Project Manager <br /> �— gj() i�s �l�� �. Tests Required <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> .� AGE �J <br /> Project Name p �I'�-,� /�� + , � � Client ❑ <br /> Sample 1/'► Locations Samples Type No. of <br /> Date Time Water Solid Notes <br /> Number Description Comp. Grab. Air Conts. <br /> 1 <br /> l <br /> e inq s y; ignatu a eceive y; ignature �� Dale(Tlme <br /> t CA OV t Dt�rnq ( 9 J r� ' <br /> Relinquished by: (Signature) Received by: (Signature) CLI Date/Time <br /> CA Oy t�t�T ML1e lG M i$/q� low <br /> Relinquished by: (Signature) Reeved by Mobile Laboratory for field analysis:(Signature) DalelTime <br /> Dispatched by; (Signature) Date/time Received for Laboratory by: Date/Time <br /> Method of Shipment: ix t1Y� 4lD J (A Laboratory Na e <br /> C4- owtomiow MUM 5�� `7 8 G <br /> Special Instructions: I hereby authorize the performance of the above Indicated work. <br /> ut <br /> GOOD C <br /> PRESERVATION <br /> HEAD SPACE ABSENT-tZ CONTAIIWRS t` <br />