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CHAIN OF CUSTODY RECORD <br /> Advanced <br /> - G�oEnvironmental, Inc. Date ��;�� � � �t=�:Page �: �— =_ <br /> --- <br /> :: <br /> 837 Shaw Road-Stockton, California-95215- (209)467-1406 - Fax (249)467-1118 <br /> r Project Manager Tests Required <br /> ClientI } 1 f} 'i' i :' E= '�, i <br /> Phone Number <br /> j Li; — _-L Invoice: <br /> Samplers: (Signature) �r ),; ! <br /> a <br /> AGE <br /> Project Name r Client El <br /> SamType No. of •''� � . <br /> Sample Location pate Time Waterple Solid r-' Notes <br /> Number Description Comp. Grab. Air Conts. <br /> na <br /> XX ' <br /> 1j 1.1c, 1 ' } y <br /> s' <br /> Late!-rime <br /> Kelm quis a y: ( i aceive y: ignature r <br /> Relinquished by: ( azure) Received by: (Signature) <br /> DatefTime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) <br /> Date(Time Received for Laboratory by: Qat [Time <br /> Dispatched by: (Signature) <br /> �r Laboratory Name <br /> Method of Shipment: <br /> ( 1 hereby authorize the performance of the above indicated work. <br /> Special Instructions: - <br />