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Advanced CHAIN O CUSTODY RECORD <br /> GeoEnvironmental Inc. Date Page __� of <br /> 837 Shaw Road- Stockton, California- 95215-(209)467-1006- Fax (209)467-1118 <br /> Client1 1 Pry tanager <br /> Tests Required <br /> P/ftone V umber <br /> _(19M)A4Q2 <br /> S ersignature) L1 � Invoice <br /> Project Name j AGE a <br /> CIWA ❑ <br /> Sample Location Sample Type ! r <br /> Number Description Date Time Water Solid NO of Notes <br /> Comp orab Air Conts <br /> E <br /> -F <br /> i 3 <br /> 66�Kx__ <br /> elinqui e y ( gna re) eco ve y igna;ure <br /> at 1TI <br /> Relmqufished by ISignature Received by (Signature) Date(T1me <br /> Relinquished by (Signature) Received by Mobile Laboratory for held analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Received lar Laborato 1I / Date me <br /> i Crj / <br /> /1 ! __ i( <br /> Method of Shipment � L orato me <br /> Special Instructions I hereby autho the Porto, nce of the above Indicated work <br /> Allifillillillill <br /> i♦ i♦ i' i♦ i♦ f♦ <br />