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Advanced CHAIN OF CUSTOD RECORD <br /> ( <br /> _ - Ile. GeoEnvlronmental, Inc. Date Page 3 of <br /> 837 Shaw Road- Stockton, California- 95215- (209)467-1006- Fax (209)467-1118 <br /> Client �l P _ Project Manager r k Tests R uired <br /> l ``V" �t 't tGEy„ �1 <br /> Phone�� 767- <br /> Samplers (Signature) Invoice <br /> Project Name44 AGE W, <br /> ��AAX��I`er C-G- LAX�S LJ. <br /> p .� Client E-] <br /> Sample Location Sample Type No of <br /> Number Description Date Time Water Air Soltd Conts �'J Notes <br /> comp Grab f /� <br /> U.) ZF ori 1� 1�- a' 1S l /I <br /> Z)Ad A, A/1 <br /> �O� <br /> I c PC)61W I v I Ll <br /> / l <br /> Refiriquis e y ignalureReceived y ignature <br /> DatelT me <br /> Relinquished by Signature) Received by (Signature) Oata/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for held analysis (Signature} E Date/Time <br /> Dispatched by (Signature) Date/Time Received for Laboratory by DateJ�2 1--1) :'� <br /> a <br /> Method of Shipment Labors Name <br /> CCA- <br /> Special Instructions It I hereby authorize the performance of the above indicated work <br /> o r� <br />