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( Advanced CHAIN OF CUSTODY ECORD <br /> GeoEnwironmental, Inc DateL Page 0t7 <br /> 837 Shaw (load- Stockton, California- 85215- (209)467 1006 - Fax (209) 467-1118 l J O9 r <br /> Client /44 4C Project Ma ager J 'fC~.1• <br /> ,A,, Tests Required <br /> Phone Number <br /> 14Zak <br /> 1�' l <br /> Jil <br /> lers {Signature) Invoice <br /> Project Name04 1A,a-M<q7Z7-(1/', X AGOG <br /> Client <br /> Sample Location Sample Type X <br /> Number Description F--Date Time Water Air Solid °O�st Notes <br /> Comp Grab <br /> Co <br /> 4!AZI 1JW0# 13c, 1 <br /> oilYA- <br /> e nquijlihpd bf I ign ure Receivedy sgnature oT7'. <br /> Refmqui ed by (Signature) Received by (Signature) <br /> Dat /T me <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatefTime <br /> Dispatched by (Signature) DatelTime Received for Laboratory by `� Date/Time <br /> Method of Shipment Laborato meA T, <br /> v i~ <br /> i <br /> Special Instructions I herebyauthors e <br /> perf ance of the above indicated work <br />