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i -,:, i i i 1• i i i � � i i i � i 1� s <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmenta , enc, Date E� Page _ of <br /> B37 Shaw Road- Stockton, Californfa-95215- (209)467-1006- Fax (209)467-1118 <br /> Client r ` Project Manag <br /> Tests Required <br /> Phone Num r <br /> Samplers: (Signature) .Invoice: <br /> Project Name AGE V <br /> ore(` Client <br /> Sample Location Sample Type ` <br /> Date Time Water Solid No. of <br /> j Number Description Aar Conts. ��' Notes <br /> Comp. Grab. <br /> die inqu a y: a atura) Received by: ignature Date/Time <br /> Relinq is ed by: ignature) Received by: (Signature) GOOD CONDITIOFI,r,,,,,, AppRpp�� daterrime <br /> ITEAD SPACE ABSENT[ <br /> RS <br /> DECHLORINATED IN LAB eO A E � <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field anal y Is: (Signature) __pRESERVHDIN I.A.El I 0V /Time <br /> VOAS Odcn t�IALS 07EB <br /> PRESMMAT70-N <br /> Dispatched by: (Slgnature) DatelTime Bece'v r l,abof ry <br /> I?alolTlme <br /> Method of Shipment: a oratory Name <br /> Special Instructions: - I hereby autho ize the performance of the above indicated work, <br /> RECD SEALED&INTACT VIA <br />