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Advanced —0 �� CHAIN OF CUSTODY RECORD <br /> C(i� <br /> Date �3 Page of <br /> GeoEnvironmental, Inc. <br /> 837 Shaw Road-Stockton,California-95215- (209)467-1006- Fax(209)467-1118 <br /> Client 6n6 MC f Polect Manager <br /> ( f��C k Tests Required <br /> Phone Number <br /> �16-7 1A0 <br /> Samplers (Signature) �D Invoice <br /> Project NameL b AGE A, <br /> P�az, o Ts Client ❑ <br /> Sample Location Samp a Type <br /> Number Description Date Time Water Air Solid �o Sf �Q W iN Notes <br /> Comp Grab <br /> rKWDLO10703 1%., VJis 7-7-03 <br /> e i uis e y ignature ace Ne tu <br /> y ignare <br /> Da1slTime <br /> 7 <br /> �e 7-7-,03 44-0 <br /> Relinquished by (Signature) Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analys4s (Signature) Datef ime <br /> 1 5- , . <br /> Dispatched by (Signature) Dale/Time Racelve r abor tory by atelTime <br /> 03 OAPV <br /> Method of Shipment <br /> Special Instructions I hereby authorize the performance of the above indicalied work <br />