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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc Date p z.. Page —I— of <br /> 837 Shaw Road-Stockton,California-95215- (209)467-1006- Fax (209)467-1118 <br /> Client I l w Project Manager <br /> �' Ytd Tests Required <br /> Phone Number <br /> M)O V'C b <br /> Samplers, (Si n tura) Irnoice <br /> Project Name ^-~~- AGE <br /> Orampo <br /> Aroperlq Client ❑ <br /> � <br /> Sample Location Date Time Sample Type No of <br /> Number Description Water Air Solid Conts � Notes <br /> Comp Grab <br /> X1 1pl 10Z 9 1 q y <br /> �")3 T_�IiIU,ti A?Pi�U R.IAT1 <br /> SE i71 UUN77M <br /> I:CHW P YFD 1X <br /> e inqu s e i na urs Received y gnatura 1�211700 <br /> 0 <br /> —Relinquished by (Signature) Received by (Signature) 'baterrilne <br /> Relinquished by (signature) Received by Mobile Laboratory for field analysis (Signature) DatelTime <br /> Dispatched by (Signature) DatelTime Rece for Laboratory �'6v — <br /> Method <br /> of Shipment LabWqry Mame <br /> Special Instructions I hereby authorize the illerformance of the above Indicated work <br /> I <br />