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Advanced ✓L CJ CHAIN OF CUSTODY RECORD <br /> Date L� -/I Page of-2, <br /> GeoEnvironmental, Inc. <br /> 4005 North Wilson Way Stockton,California-95205-(209)467 1006-Fax(209)467-1118 <br /> CllentProject Manager r <br /> 0 � � i� Al <br /> u� Tests Required <br /> Phone Number , /�7✓ <br /> Samplers (Signatur ) Invoice <br /> U <br /> Project Name f L � �� AGE <br /> Client ❑ <br /> Sample Location Date Time Sample Type Solid No of Notes <br /> Comp <br /> Number Description Water Air Cants <br /> MGrab ` � <br /> 'U'` /T-f �y�l"� ; 3x1A I I <br /> __MW_Z 6 12 7 4 <br /> lv_� <br /> L 10 <br /> -12 <br /> 31 <br /> Relin by ( Ignatur eceie y (Signature) Qate(rEme <br /> r - ltT3 '3.9 <br /> Relinquished by (Signature) Received by (Signature) Date rime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time eive for Labor ory by Date/Time <br /> t �4� 60U <br /> Method of Shipment Laboratory Name <br /> C <br /> Special instructions I hereby uthorize the performance of the above indicated work <br />