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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc Date a� Page --i—of <br /> 837 Shaw Road - Stockton, California- 95215- (209) 467-1008- Fax (209)467-1118 0S <br /> Client ) c G Project Manager �C} <br /> �� Tests Required <br /> P one hlumber <br /> DC Vb 7- <br /> Samplers (Signature) (� Invoice <br /> Project Name ll AGE <br /> Client ❑ <br /> Sample Location Sample Type , <br /> Date Time Water Soled No of Notes <br /> Number Description Comp crab Air Conts <br /> y36 C AAJ 6L 03Ytb <br /> t-,,v3 6'D ff X <br /> 6C N%W 6 F <br /> einquis WK <br /> ture eceive y ignature <br /> zo, <br /> elTt=� S f li d <br /> Relinquished by (Signature) Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) +fir Date/Time <br /> Dispatched by (Signature) Date/Tome Received for Laboratory by \ Date/Time <br /> Method of Shipment Labo ry Name <br /> C � <br /> Special lnatruetwns 1,k �� I Kereby authorize the performance or the above indicated work <br /> 4 <br />