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( Advanced CHAIN PF CUSTODY RECORD <br /> GeoEnvironmental, Inc, Date d Page '2--of Z— <br /> 837 Shaw Road- Stockton, California- 95215- (209)467-1006- Fax(209)467-1118 L— O(0 LJ <br /> Client � Project Manager <br /> Tests Requir <br /> DA Q, 41 7 <br /> P ne umber <br /> 1?t'J <br /> Sam rs� Signature) Invoice <br /> Project Name AGE <br /> Client ❑ <br /> Sample Location Sample Type , <br /> Date rime Water Solid No of Notes <br /> Number Description Comp Grab Air Cants <br /> 7744 <br /> Relinquish y g at re ece ve y 3gnalure ate[Time <br /> Aso <br /> Relinquished by (Sig ure) Received by (Signature) DatelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Received for Laboratory by DLl-10-atelTi e <br /> Method of Shipment Lab N me <br /> Special Instructions I hereby aut ze the rmance of the above indicated work <br />