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f <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmentai, Inc. Date o Xs s Page ._1_.._ of -1 <br /> of Nor7hem Calrfornur <br /> 1803 West March lane,State A Stockton, California-95207-(209)956-0264-Fax(209)956-0700 <br /> Client ,Q-5 <br /> Project Manager Tests Required <br /> C <br /> Phone Number <br /> 2nq ) G5 og:�k y <br /> Samplers (Signature) Invoice <br /> Project Name AGE <br /> A Vi C' Ro Dq-A4;t-5 �t-' Client ❑ <br /> Sample Location Sample Type , w <br /> Number Description bate Time Water Air Solid of <br /> o Notes <br /> Comp Grab <br /> "W �.- -w <br /> t1A <br /> r <br /> o rnquks e y ( ignatwe) ec d by tfln re Date/Time <br /> 7 • S7ANpaR0 <br /> 1� 2SQa <br /> R utshed by ignai Hacay (Si nat r <br /> r'nvI£ <br /> Ef}5� [ /6 ateJTame <br /> l <br /> Relinquished by (Srgnatura) Haceived obtlu La ratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time lloceivod for laboratory by Data/Time <br /> i <br /> Method of Shipment ! Lab ratory Name <br /> Speciallnstructions <br /> I herobf authorize tite performance of the above Indicatod work <br /> r <br /> cAOL <br /> 411111111111111111 itttttttttt� t� i �f1r rr <br />