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( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnviron mental, Inc. date NPage �- of <br /> I <br /> 837 Shaw Road- Stockton, Callfornra- 95215- (209)467-1006 Fax (209)467-1118 <br /> Client Project Manager tt N Tests Required <br /> 0V <br /> P one N mbar <br /> Samplers {Signature) Invoice- <br /> Project Name W(AX ��-'�+I l� �L AGE <br /> � Client ❑ <br /> Sample Location Sample Type �y r <br /> DNo <br /> ate Time Water Air Solid Conts Notes <br /> Number Description Comp Grab <br /> AW 241 <br /> quis e y eceive y ignature Date/Ttme <br /> Jam. <br /> upshed by (Signa ure) Received b S� ,� �� <br /> y ( gnature) Date/Trme <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date rams Received for Laboratory by DatelTi a <br /> Method of Shipment Labo or ama <br /> e y ~ } `Y �`EtZ <br /> �� �- <br /> Special Instructions ClI hereby authorize the performance of the above indicated work <br /> I <br />