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Advanced CHAIN OF CUSTODY RECORD <br /> Date Page of Y- <br /> GeoEnvironmental, Inc <br /> 837 Shaw Road- Stockton, California 95215- (209)467 1006 Fax (209) 467-1118 0 <br /> 1.� 1 <br /> Client Project Manager /Tests Required <br /> -?/ll&�& X <br /> Phone Nu b,rr <br /> Samplers (Signature) Invoice <br /> — AGE <br /> Protect Names i �r f /Y f � Client ❑ <br /> ,J Sample Type <br /> Sample Location Date Time Water Solid No of Notes <br /> Number Description Comp Grab A+r Conts <br /> ell q y,( ign tur ecerve y (Signature) "'a"lme <br /> Date/Time <br /> Relinquished by (sign ature) Received by (Signature) <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) <br /> Date/Time lReceived for Laboratory b Date/Time <br /> Method of Shipment La r ory ra <br /> me iec� <br /> I hereby authorize the perlormance of the above indicated work <br /> SQecial instructions _ � <br />