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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date D` Page of <br /> C 837 Shaw Road-Stockton, California-95215- (209)467-1006- Fax (209)467-1118 <br /> Client COOV1>61 P o act Manager <br /> OL A 1--e_1� Vxa La[L Tests Required <br /> Phone Number <br /> Moo--- <br /> Samplers (Signature) ^ Invoice <br /> Project NamePrvf <br /> � AGE � <br /> Oc"D "ev Client ❑ \ <br /> Sample Location Sample Type <br /> Date Time Water Solid No of Notes <br /> Number Description Comp Grab Air Conts <br /> r� ��Gx l Q� )< x x <br /> MAD l3 Z (rw�C <br /> I35" X I <br /> mqu a e �y g tura Re—calveby (Signature) 7D;,;, <br /> ra I 1�'aa <br /> inquished by (Signature) Received by (Signature) ata me <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time lRecelve,0 for Laborato AV 9atefTims <br /> l r7a Aoe4- -. <br /> Irtethad of Shipment © Laborato Narge 4w— <br /> Special <br /> Instructions 1 hereby authorize t performance of the above indicated work <br /> I <br />