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Advanced CHAIN OF CUSTODY RECORD <br />GeoEnvirontnental, Inc. Date � ` ` Page of <br />of Northern California <br />1803 West March Lane, Suite A • Stockton, California - 95207 - (209) 956-0264 - Fax (209) 956-0700 <br />ClientProject Manager <br />Tests Required <br />e Phone Number <br />Samplers: (Signature) , Invoice: <br />ct Name <br />Pro e n - AGE <br />j l Client p <br />l `)LAM <br />Sample Location Sample Type No. of / <br />Date Time Water Solid <br />Number Description Comp. Grab. Air Conts. <br />r <br />C. <br />,93 <br />3 <br />Relinquished a y: ignature el y: gna re !,� 3®'G7 �„� . / Date/Time <br />4-2 Li .tea i <br />Date me <br />Relinquished by: (Signature) _ Re ed by: (Signa re) VOAS 0&G M T <br />Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Sign CONDTjON PRESERVATION Date/Time <br />iY APPROPRIATE <br />Dispatched by: (Signature) Date/Time Received for aboratory RS Date/Time <br />i <br />Method of Shipman ,4 L Laboratory Name <br />1 - 1 Cei f✓�Gt c <br />SpecIdl Inattuctiona: 6# I hereby authorize Re performance of the above indicated work. <br />an <br />$oCv <br />