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( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Dace Q Page ---� <br /> 897 Shaw Road-Stockton, California- 95215- (209)467-1006 - Fax (209)467 111 a 0 <br /> Client r� VLA P ct Manager TOM Required <br /> Phone Number <br /> �_ vara <br /> Samplers (Signature) Invoice <br /> Project Name ,PrG . AGE <br /> ` L Client ❑ <br /> Sample Location Sample Type No of �1 � <br /> Number Description Date Time Water Air Solid Goats h` Notes <br /> Comp Grab <br /> v,ftit 122,3 1 <br /> I 31-D <br /> Wuvlk. •-90 t 3s <br /> Relinquished by ig to a ecetve y (Signature) ata/Tt e <br /> 620 <br /> e inquished by �gnature) Received by (Signature) Date ime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysts (Signature} DatafTime <br /> Dispatched by (Signature) I)atelTime Received for Laboratory Date[ im <br /> b e <br /> Method of Shipment La atoryF Name <br /> Special tnstructions I hereby authorize the performance of the above Indicated work <br />