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4 L=I Advanced CHAIN OF CUSTODY RECORD <br /> J GeoEnvironmental, Inc. Date Page _,�- of`�--- <br /> 837 Shaw Road-Stockton, California- 95215 - (209) 467-1006 - Fax (209) 467-1118 <br /> ClientAZf r Project Man ger Tests Required <br /> Ph Ane Number <br /> k <br /> Sam lers (Signature) Invoice <br /> Project Name t � AGE <br /> t�"_ Client ❑ <br /> Sample Location Sample Type <br /> Number Description <br /> Date Time Water Air Solid No of Cants Notes <br /> comp-1Qrab <br /> G - 13 55' <br /> It <br /> m is y i nature ece ve y ignature <br /> {]ate(Tlme <br /> Re inquished by {Signa r ) Received by (Signature) <br /> f)atelTima <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Datelfime <br /> Dispatched by (Signalure) bateffime Receiv r Laboratory b tyate/Time <br /> Method of Shipment IM <br /> Laboralar a /d <br /> aAAlA Ati <br /> S actall�s�iuctl nar v� <br /> 4 I hereby au o e the arl rmance of the above Indicated work <br /> i <br />