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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date Page <br /> 837 Shaw Road- Slockton, California- 95215- (209)467-1006- Fax(209) 467-1118 10 � - 2 2 <br /> 7 <br /> Client �-r l�J�. Project` ge l <br /> r Tests Required <br /> hone umber <br /> Samplers (Signature) Invoice <br /> Project Name rZ AGE l Client ❑ <br /> 4 <br /> Type Typ <br /> Sample Location SampleNo of <br /> Number Description Date Time Water Air Solid Conts Notes <br /> Comp Grab <br /> A / /1/1 <br /> /V1 <br /> �t -� W t�� <br /> e-Relinquish y (Si ature) ece ve y gnature atefT e <br /> 79 <br /> 3? <br /> Relinquished by (Signature) Received by (Signature) Datefifirne <br /> Relinquished by (Signature) Received by Mobilo Laboratory for field analysis (Signature) Date(Time <br /> Dispatched by (Signature) Date/Time Received for Laboratory by DatelTi e <br /> 9 <br /> Method of Shipment y ` 3 <br /> Labor at Name <br /> Ca <br /> 1l L t <br /> Special Instructions i hereby authorize the performance of the above indicated work <br />