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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date <br /> 63 zzq. page -3� of <br /> 837 Shaw Road -Stockton, California- 95215-(209)467-1006 -Fax (209)467-1118 9 �} <br /> Client 4 V I �L 0 Proje anager / Tests Required <br /> I ?P ii <br /> .I;q le- <br /> Phone Number <br /> de)ery <br /> Samplers (Signature) Invoice <br /> Project Name I AGE <br /> U ! Client ❑ <br /> Sample Location Sa p e Type <br /> Number Description <br /> Date Time Water Alr Solid C r of Notes <br /> Comp Grab <br /> +'-we-h63 z3P 1,.r 0 1716 <br /> A40 7 `+ 7A rf 5Y5 <br /> µi17 51f ► µk� Z f( ! C <br /> 71 /vLt'u '7 C- d t c{c3 <br /> He" qui a <br /> (Signature) stews y rgnalure L <br /> Datel7rme <br /> � Z �C/ <br /> Relinquished by (Signature) Received by (Signature) DatelTrme <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) � � DatelTime <br /> Dispatched by (Signature) Dalel7ime 78� <br /> for Laboratory by Dateffime <br /> meetLob ( zj <br /> Method of Shi <br /> _az <br /> P r.0ma <br /> S� <br /> Special Instructions L..7, � f here uthor ze the performance of the above indicated work <br />