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i Advanced CHAIN OF CUSTODY RECORD <br /> -� GeoEnvironmental, Inc. Date Page <br /> 837 Shaw Road Stockton,California-95215 - (209)467-1006- f=ax (208)467-1118 <br /> y_ Pro Ma )gar <br /> / <br /> � f Tests Required <br /> Phone Number <br /> ' - 7 <br /> Sam p rs (Signature) Invoice <br /> Project Name AGES <br /> Client ❑ <br /> Type Solid <br /> Sample Location No of �� <br /> Number Description Date Time Comp Sam !e Typrab qtr Conts Notes <br /> x�;� ,t r��,u ;� �1 �✓1� ! 1 <br /> Z-V'5 1 I <br /> 36 <br /> e+n s e gnature Received by ignature DatelTtme <br /> ®yr0AZ'Y/6c <br /> +nquished by (Signature) Received by (Signature) Datelrime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysts (Signature) Date rime <br /> r <br /> Dispatched by (Signature) DatelT+me Received for Laboratory b 1 Dare/Tlme <br /> .JI 11-4 - 3 <br /> Method of Shipment r Labor ry NajR+el <br /> /[.�) (/ <br /> Special Instructions I hereb authorize the performance of the above indicated work <br /> � I <br />