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s � � <br /> ( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date lo`l Page '�- Z— <br /> 837 Shaw Road - Stockton, California- 95215 - (209) 467-1006- Fax (209)467-1116 <br /> Client Project Manager <br /> 'Brt-CXV) tIWtew, Tests Required <br /> Phone N tuber <br /> D0 CCS <br /> Sam lers; (Signature) Invoice: <br /> Project Name 7Date <br /> AGE <br /> Client ❑Sample Location ample TypeNumber Description Time Water Air Solid Contst Notes <br /> Camp. Grab. <br /> l I�fi7 <br /> dciu hoc Jit�tl z�(�t(c�� X c' <br /> 1,tr�} M.�a1 <br /> r <br /> YL <br /> ece ve y: IsIgnaturs) :J�T <br /> 1 pate�T(ime <br /> Relinquished by: (Signature) Received by: (Signature) Datal7ime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) L DatatTime <br /> Dispatched by: (Signature) Dateffime Received !or l mboralory by: DareJ73me <br /> Method of Shipment: Laboratory Name <br /> C)` -eA— V1 yNt <br /> Special Instructions: _ i here uthorize the performance of above indicated work. <br />