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_ Advanced <br /> CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc Date Page `� of� <br /> 4005 North Wilson Way-Stockton,Califomia 95205 (209)467 1006-Fax(209)467-1118 <br /> Client , Project M .ag <br /> Tests Required <br /> P ne Number <br /> 7 <br /> Samrs (Sign ture) Invoice <br />� <br /> Project Name AGE [/ <br /> ' Client ❑ <br /> / { ll� �/ <br /> Sample Location Sample Type No of r� <br /> Number Description Date Time Water Air Solid Conts Notes <br /> Comp Grab <br /> 58937 <br /> [ 58938 <br /> o- -;A'-0 �� Il - 58939 <br /> tt_ o ,0 U 5 8 9 4 0 <br /> 58941 <br /> 58942 <br /> 58943 <br /> e mqui d iby ignature ecei e y (Signature) Date/Trme <br /> Relinquished b (Signature) V Received DatelTime <br /> 1� <br /> Relinquished by (Signal t�OlY�IIIO`Y ,qr g� by M e Laboratory for held analysis (Signature) Date/Time <br /> 00 PC hnsa� ��^ <br /> D+spatched by (Signarur Received for Laboralor b Date/Time <br /> Method of Shipment La oralory Name <br /> Special Instructions t hereby authorize the erformance of the above indicated work <br />