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CHAIN OF CUSTODY RECORD <br /> { Advanced Dare 2127/01 Page or_ <br /> Jo <br /> GeoEnvironmental, Inc. 7 <br /> m <br /> 837 Shaw Road- Stockton, California-95215- (209) 467-1006- Fax (209) 467-1116 <br /> r <br /> N <br /> client t .56 +-VA e-S Project Manager � � Tegrs Required m <br /> Phone Number r <br /> m <br /> Invoice: O <br /> Samplers: (Signature) m <br /> yYi� AGE ❑ <br /> Name <br /> G-7- <br /> Project Sample Type t! Client ❑ m <br /> i <br /> Sample Location Solid NO of Nates <br /> Number Description Date Time Water Comp. Grab. <br /> p Air cords. <br /> { C 33 -2r <br /> y (red—5 r ✓ t f�c.p <br /> !chit �` 9z7ej r <br /> y — l0 4 L7 r �13 ✓ x m <br /> ✓ CrF <br /> ib=zI 1 �- <br /> B 2Y <br /> oat ime <br /> 9 is a y: ( i9nal ace a y= ignature <br /> /y��y� !/ ateRlme <br /> J elinqu had by: an ure): Received by: (Signature) ✓�J /' <br /> oalerrlme <br /> Relinqulshe by: (Signature) Received by Mobile Laboratory for field analysis: I gnaw a) <br /> Dalerrime <br /> Dispatched by: (Signature) Datafrlme Recaived for Leboralory by: <br /> Laboratory Name <br /> Method of Shipment: c! 1 <br /> I hereby authorize t ce of the above Indicated work. r <br /> Special Instmctions: /� - <br />