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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnv;ronmental Inc L Date s Page e of—� <br /> 4005 North Wilson Way-Stockton California 95205-(209)467 1046-Fax(209)467-1118 <br /> Project Manager <br /> Client � �� Tests Required <br /> Vrl Cc t'1 <br /> Phone Number �0 <br /> Samplers (Signature) Invoice <br /> Project Name t4 <br /> � �\� � Client ❑ <br /> Sample Location Sample Type No of <br /> Number Description pate Time Water Air Solid Conts Notes <br /> Comp Grab <br /> q30 58771 <br /> - 58772 <br /> TD- f� D CQ � 5®773 <br /> 55774 <br /> 39�� 5775 <br /> 0q J0 _ i�3� 55776 <br /> e urs ed y 1 rgna re� eceive y rgnature _ _ <br /> / � }n Date/Time <br /> Relkiii.itshed by (Signature) Received by (Signature) L� Dale(Tlme <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DateirTime <br /> Dispatched by (Signature) Date[Time Received for_Laborafory Date/Time <br /> i <br /> Method of Shipment tr C 1��1� n aborator Name ) <br /> c7--� o v�� n ► � Y J " iriL U G n� 6 <br /> Special Instructions I hereb authorize the performance of the above indicated work <br /> 6OOD CO TIM ArROPR14E <br /> HLEA3 SPACP ABSENT CONTAlNt <br /> '1� <br />