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• i i <br /> Advanced CHAIN OF CUSTODY RECORD . <br /> GeoEnviror mental Inc. Date Z-2 o Page —�L of <br /> of Northiem Calrfonua <br /> 1803 West March Lane,Suite A-Stockton California-95207 (209)956.0264 Fax(209)956-0700 <br /> Client P ` Project Manager j <br /> Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> Project NameAGE <br /> �4 L 5 1 <br /> Client ❑ <br /> Sample Location Sample Type Solid No of Notes <br /> Number Description Date Time Water Air Conts <br /> Comp Grab <br /> 1S 7-Z c <br /> "Zato <br /> 2 � z ' X13 <br /> xx <br /> e in is ed y ( ignature) Received by (Signature) DatelTime r <br /> 51K)rV01*V� d?—-x3� <br /> Re inquished by Signature) Received by (Signature) DatelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatetTime <br /> Dispatched by (Signature) Date/Time Re i ed Labora ry b Date ime <br /> i <br /> Method f Shipment Laborator Name <br /> a aALVva, ty q-)T /�-' k',A I � 4 1'C" 1 <br /> Special Instructions 1 I hereby authorize the pert rmance of the at indicated work <br /> C7C,<yC U l <br />