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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnviro nmental Inc. �' C>�g Date - ' Page / of / <br /> 837 Shaw Road -Stockton, California-95215- (209)467-1006-Fax(209)457-1118 <br /> Client X/1Project Manager <br /> 1� &/'I-L � Tests Required <br /> V Phone Number <br /> Samplers. (Signature) JInvoice <br /> a <br /> Protect Name � � <br /> AGE 8/ <br /> pla <br /> /� ,.,4 � C. y Client ❑ <br /> G i <br /> Sample Location Sample Type No of <br /> Number Description Date Time Water Air Solid Corn$ Notes <br /> Comp arab <br /> r <br /> ifiy <br /> I <br /> \ l.. ..n A .. C[ <br /> I <br /> e�nquis { <br /> zm <br /> eceive y gnature f)ato/Timo <br /> IVY �� — <br /> �inquished by (Signature)- Received by (Signature) 6i � 7 /7` � Daterrima <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) 1 Uate/TEma <br /> Dispatched by (Signature) DatelTime a dyed for Laboratory by � � Daterrime <br /> L <br /> Method of Shipment Laboratory Name_ <br /> CI <br /> eci Instructions I hereby authorize the rformance of the above Indicated work <br /> _. 14& <br />