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Advanced CHAIN OF CUSTODY ECORD <br /> GeoEnvironmental, Inc. Date[()-2Z'G k0 Page of— <br /> u/ Noidierrt Calijoinrrf <br /> 1803 West March Lane Suite A Stockton California-95207 (209)95"264-Fax(209)956-0700 <br /> Client ;_ i E 1` Co Q 1,W_ Protect Manager C\)C\)q I <br /> IG(4, Tests Required <br /> Phone Number <br /> — ® a <br /> Samplers (Signature) Invoice <br /> Protect Name AGE <br /> Client ❑ <br /> Sample Location Sample Type No of <br /> Date <br /> Number Description Time Water Afr Solid Conts �/ Notes <br /> Comp Grab <br /> P7--'�� *7 S5 f .�.9 % gays <br /> s1�P• <br /> P �_ X x <br /> y5 o Lk Iz,A <br /> P-7 -5D 50 1 1xxx <br /> 2 : <br /> P� -Z<) _N�P"4�6 �zo V,V,7()P <br /> ujis e y Signature) Received by (Signature) <br /> G9-PDate/Time <br /> Relinquished by ( ig ure) Received by (Signature) DatelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) <br /> Data/Time <br /> Dispatched by (Signature) Date/Time R for Labora y by DatelTime <br /> Method of Shipment Mbar tory Name <br /> /Special Instructions I hereby authorize the performance of the above indicated work <br />