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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc, Date /V Page ! cit�_ <br /> 837 Shaw Road Stockton, California - 95215 (209) 467-1006 - Fax (209)467 1116 <br /> Client � Project Manager /� �� ��..'f Y� �CL_S� ��'. �yY1r1 ��� �CCS.✓ +�I7 Tests Required <br /> Phone Number <br /> TO <br /> D?7UOSq amplers (SI Tlure) ^� Invoice <br /> AGE <br /> Project NameC- C�Y ��i,� w Qo-G Client <br /> Sample Location Sample Type No of ~ \ <br /> Number Description Date Time Water Air Solid Cants dotes <br /> Comp Grab <br /> I <br /> 7w - <br /> �' <br /> e4s' <br /> mw- gz7ai r �8 )K� <br /> 0 <br /> mw -iz e <br /> Mui-1 <br /> =ehnqmslhZed (Signature) <br /> {Signatur Received y ignature f)ate/Time <br /> D 1 ,0Z /700 <br /> Received by (Signature) Dat (Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field inelysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Re-erved for Laboratory b A� DatefTime <br /> Method of Shipment Laboratory <br /> Special instructions VOAs 0&0 N=ALS OTHU I hereby authorize the erformance of the above indicated work <br /> 1.4T _ CoiV!'AI1VI3gS_ _. <br /> TED IN PBE=VJWJNyiAA <br />