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•. cj-L,�s3- � i <br /> Advanced (� CHAIN OF CUSTODY RECORD <br /> --- GeoEnvironmental, Inc. Date Page - Of _ <br /> 837 Shaw Road- Stockton, California-95215-(209)467-1006- Fax (209)467-1118 <br /> e "I".Ve,I 94badweaeA y.,eoPm <br /> Client Pr ' Manag r <br /> . C Tests Required <br /> DC <br /> Phone mber <br /> u . <br /> D <br /> Samplers: (Signature) Invoice: <br /> Project Name AGE <br /> bw Client <br /> Sample Location Sample Type No. of <br /> Date Time <br /> Number Description Water Air Solid Conts. Z� Notes <br /> Com . <br /> p iirab. <br /> 7-15 7. l C X X <br /> inqu[is�a y: ignature ace ve y: igna ure D el7tme <br /> y`.' I � <br /> Re inquished by: (Signature) Received by: (Signature) atelT me <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) Y' Date/Time <br /> ­!S <br /> Dispatched by: (Signature) Date1'Flme Race ved for Laboratory by: Datel ime <br /> Method of Shipment: Labor pry Name <br /> L ow ER LA-65 <br /> Special instructions: I hereby authorize the performance of the above indicated work. <br />