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( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvzronmental, Inc. Date Page Z of. Z, <br /> 837 Shaw Road- Stockton California 95215- (209)467 1406 Fax (209)467-1118 <br /> Client Project Manager <br /> Tests Required <br /> Phon Number <br /> Samplers (Signator ) Invoice <br /> Project Name f i� AGE <br /> CII <br /> ant p <br /> Sample location Sample Type <br /> No of <br /> N <br /> Number Description Datta Time Water Solid � <br /> Comp Grab Air Conts Notes�� <br /> 83469 <br /> i <br /> 1 <br /> Re inqu s y g tura <br /> Received y (Signature) <br /> Date/T me <br /> Relinquished by I at Received by (Signature) `� <br /> D elTime <br /> a <br />� <br /> Relinquished by (Signature) � <br /> Received by Mobile Laboratory for field analysis (Signature) Date/Ti <br /> Dispatched by (Signature) Date/Time <br /> Received for af}orator y at/e/Fime <br /> Method of Shipment <br /> Labor cry ame <br /> anz / C <br /> Special Instructions 14MS MD <br /> vo I hereby a or€xe the performance of the above Indicated work <br /> GOOD CONDITION P1?CPIiIaTI00_PM SPACE ' <br /> tc i L <br />