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Advanced CHAIN OF CUSTODY RECORD <br /> =_- GeoEnvironmental Inc Date 6--m-pq Page _� of <br /> I" 837 Shaw Road - Stockton California- 95215- (209)467-1006 - Fax (209)467-1118 <br /> Client �bAvV� Q Project Manager Tests Required <br /> Phone Number <br /> CM4) 4(a- - 106� <br /> Samplers (Signature) Irnfoice <br /> Protect Name ('os neo AGE <br /> `[?) <br /> - y � Client ❑ <br /> Sample Location Sample Type Solid No of Notes <br /> Date Time Water <br /> Number Description Comp Grab Air Conts <br /> 11705 <br /> Relinquished y ( ignatur) f Receivedy igri ure Date/Time <br /> Relffikluished by (Signature) <br /> ignature) Received by (Signature) DatelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) 5 Date/Time <br /> Dispatched by (Signature) Date/Time Received for Laboratory by Date/Time <br /> Method of Shipment Laboraio Name �,� �I <br /> Com. Ne"[GHQ- r�-rT <br /> Special instructions I hereby authorize theperformanceof the above indicated work <br />