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Advanced CHAIN OF CUSTODY RECORD i <br /> GeoEnvironmentai, Inc. <br /> Date � Z�r `�I Page _� of � <br /> 837 Shaw Road - Stockton,California-95215- (209) 467-1006 - Fax (209)467-1118 <br /> Clientr Project Manager <br /> Tests Required <br /> P ne Number <br /> z i 247- 1606 <br /> Samplers (Signature) Invoice <br /> Project Name rl AGE <br /> Chent <br /> Sample Location Sample Type No of �(" ��n/ <br /> Number Description Date Time Water Air Solid Cants Notes <br /> Comp Grab <br /> -4, D -Z45 X' XIO I I <br /> 1/ <br /> 1L'l / X <br /> [ ( L1q X X <br /> X K X <br /> eI qu e y ignatu ecewe y (Signature) Qat frim <br /> - 1 ZCe �L j <br /> 'Relinquished by ignature) Received by (Signature) Qata/T me <br /> Rehnquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) 'S;T A—`�` <br /> Date(Trme <br /> Dispatched by (Signature) Datefrime Received for Laboratory by Datefiime <br /> Method of Shipment Laboratory me <br /> fca <br /> Special Instructions � f �y�� -- (� 1 hereby authorize the performance of the above Indicated work <br /> Lf <br /> i za <br />