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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironniental, Inc Date -0 Page of :3 <br /> ~" 837 Shaw Road - Sto,Mon, California-95215- (209)467-1006- Fax (209)467-1118 2 r-)G ZuD�,� <br /> ClientProject Manager <br /> ti ® ! -c"' c F +` 0�t n i�e-r- Tests Requiredl� ( ; P hone Number <br /> _ Samplers (Signature) Invoice <br /> Protect Name � / <br /> Client 09❑ <br /> Sampfe Type C'a <br /> Sample Location No of <br /> Number Description Date Time Water Ali Sated Conts Notes <br /> Comp Grab <br /> CPT-4- gp t54 h-lq-01� Gq �z 3 14A A t j <br /> Crf-I- (0 (4-R 19I o 7� <br /> P1�I — 0 <br /> lu-�Xj <br /> C P T-2> -- 00 I� x <br /> ?T--S <br /> e q a y ( ignalure) ce a (SignatureDale(Time <br /> `-U 3/I <br /> R quashed y (Signature) Ret dd by (Signa re) Date(Time <br /> Relinquished by (Signature) Rece d by mobile Laboratory for field analysis (Signature) Date/Ttme <br /> Dispatched by (Signature) Date/Time Received for Laboratory by Date/Time <br /> Method of Shipment Laboratory Name <br /> &-s CJ rr.-f 4L <br /> $�RC1al(nst�ucl�ans ihere y a ftorize the performance of the above indicated work <br />