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( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc Date LOO�Ipage A— o--A- <br /> 837 Shaw Road - Stockton California- 95215- (209) 467 1006- Fax (209) 467-1118 ^ y <br /> Client ` � 1 Pre aglsV� Tests Required <br /> P one N ber <br /> -I-, � 0 <br /> Sa leis (Signature) , Invoke <br /> Project Na rn� `� } I ,�,. - i � � �j� AGE <br /> Client ❑ <br /> Sample Location Sample Type <br /> Number Description Date Time _ Water Air Solid Co� <br /> �y� Of � Notes <br /> Comp Grab <br /> VJ-JJfl <br /> PUUA;' y0r-- y- y- <br /> &&kJ k--3 A \ I I <br /> opt <br /> Re 1pd by (Sign atu ecelve y (Signature) <br /> DatelT me <br /> Re shed by {Signature} Received by (Signature) <br /> DatelTrme <br /> Relinquished by (Signature) Received by Mobile Laboratory for held analysis (Signature) Date/Time <br /> Dispatched by (Signature) DatelTrme Received for Laboratory by DatelTime <br /> Method of Shipment /^� � `.,� Laboratory H �''��"� � ��` <br /> ��,J� l',I�eA 7/ � <br /> Special Instructions � � til i hereb uthorize the per'ormance of the ove indicated work <br />