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• • 0 <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date 12- ltl � Page --� of <br /> of Northern Califonua <br /> 1803 West March Lane, Suite A-Stockton, California 95207 (209)956-0264 Fax(209)956-0700 <br /> Client iiJ Ix. Po Project Manager <br /> - T� 2 Tests Required <br /> Im Phone Number <br /> c5 �" 0LIGL1 <br /> Samplers (Signature) Invoice <br /> Project Name AGE�- <br /> L �5 �, k� Client ❑ <br /> Sample Location Sample Type <br /> Date Time Water Solid No of Notes <br /> Number Description Comp Grab Air Conts <br /> b,R s <br /> 036 �� UXXYY <br /> co <br /> O � t tt (rl n <br /> V <br /> X�X <br /> e'nqurs ed by (Signature ecerved y (Signature) n ^ Date/Time <br /> %/rJ f 5 fJ -Z g 4 <br /> C <br /> Relmqui ed bye((Signature) Received by (Signature) f� / Date/Time <br /> x`10 14�, <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date[Time <br /> Dispatched by (Signature) Date/Time Recei f Labora y by <br /> ,-;?2at IT e <br /> , 9 0., L <br /> Method of Shipment LaboratoryName <br /> Special fnstructions I hereby authorize the performance of the above indicated work <br /> ix GAt q I CX== <br /> �— <br />