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Advanced <br />GeoEnvironmental, Inc. <br />CHAIN OF CUSTODY RECORD <br />Date , Page of - <br /> <br />837 Shaw Road - Stockton, California - 95215 - (209) 467-1006 - Fax (209) 467-1118 - <br />, <br />Client • af,e) - A ii,...a, Project Manager , , <br />Tests Required <br />Phone Number 1- <br />/9134C <br />/ <br />Samplers: (Signature) Invoice: <br />Project Name pi <br />04111 - MUS 1 ii..3:•, <br />- :1 i .- • <br />ti zt-V.--i (3;311 1-/ <br />/ <br />Client . <br />Sample Location Sample Type No. of / ,l..1‘14 4 <br />Number Date Time Water Solid Notes Description Comp Grab. Air Conts. <br />, tm 0 i-, •---- 042- - 3Y5 I <br />muw-1 9 e- , <br />17 <br />ci ?..-c., <br />11 4- ,--.-= )( )( • <br />e iri9i415 e• y ( ig atur ,), . _ eceive• • . ignature Date/Time <br />VeDrel. ( <br />Dateffime Relinquished by (Signature) Received by: (Signature) <br />Date/Time Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) <br />Dispatched by: (Signature) Date/Time Received for Laboratory b • <br />Mr/ <br />Date/Time <br />Method of Shipment: <br />• Lab.j fit° <br />..4. <br /> y Name <br /> <br />-" 2 " / -7-- -"s A, 4 / 6-C.-#1 <br />Special Instructions: I hereby authorize the performance of the above indicated work. <br />-- <br />kgift