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t Advanced CHAIN PF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date 24t, Page -4- Of <br /> 4005 North Wilson Way Stockton,California-95205-(209)467-1006-Fax(209)467-111$ <br /> Client Project Manager <br /> Tests Required <br /> 1 j f P one Number <br /> J <br /> Samp rs (Signature) k Invoice <br /> Project Name ! � D �� AGE <br /> �t f Client ❑ <br /> Sample Location Sample Type No of <br /> Number Description <br /> Date Time Water IAir Solid Conts Notes <br /> Comp Grab <br /> e rn s e y ( ignature) Received by (Signature) Da /Time <br /> Relinquished by (Signatur Received by (Signature) ! ate/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Daterrime <br /> Dispatched by (Signature) Date/Time Receiv for Latory y <br /> =141 DatelTrme <br /> Method of Shipment Laboratory me <br /> Special Instructions ! hereby a oe the per ormance of the above indicated work <br />