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CHAIN OF CUSTODY RECORD <br /> t Advanced Date 6Z Page 2 of <br /> GeoEnvironmental, Inc. <br /> 837 Shaw Road - Stockton, California- 95215- (209)467-1006 - Fax j209)467-1116 d <br /> Client Aw,, Proect Manager Tests Required <br /> Phone Num r <br /> Samplers (Si nat �nt'y Invoice <br /> AGE JS;- <br /> Project Name TF, / 1 V" b Client ❑ <br /> Sample Type `�' <br /> Sample Location Date Time Water Solid No of Notes <br /> Number Description comp Grab Air Conts <br /> e inqui y igna �. ece ve y rgnature D tel�rme <br /> Relinquished by rgnature) Received by (Signature) <br /> `✓ Date(Trme <br /> Rehngwshed by (Signature) Received by Mobile Laboratory for field analysis (Signature) ` DatelTrme <br /> Dispatched by (Signature) Datelrrme Received for Laborato DatelTime <br /> �iy 'r <br /> Method of Shrpme ato Name L <br /> G <br /> Special instructions 1 hereby authorize the part mance oft a above indicated work <br /> �l <br />