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' i• � I� i• � � Ili r � i• f• il• � � <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date page - oPr2 _ <br /> 837 Shaw Road - Stockton, California- 95215- (209)467-1006 - Fax (209) 467-1118 <br /> Client Project Manager Tests Required <br /> /6!-1 i' & <br /> Phone Number <br /> Samplers: {Signature)'a Invoice: <br /> AGE <br /> Project NameS{ ;- tom-- ' = DClient TBI �16 P&P.,�,R, 5-I �� I <br /> Sample Type r` <br /> Sample Location Date Time Water Solid No. of �� 1.�' Notes <br /> Number Description Comp. arab. Air Conts. <br /> .rte 66176_; iv , r )~�� lTIC f <br /> /S -1,� <br /> tCFlt° VC <br /> A3 Odo 11' <br /> PPMERVkTION <br /> GOOD C NDITION APPROPR LATE <br /> 2=S tw"z AM CONTAIN <br /> DE011M UM7ZDIN ' <br /> PtBSE$ 1At <br /> Rol' y: ignature ece ve y: (Signature) DatelTime <br /> Relinquished by: (Signature) 61 Received by: (Signature) DateMme <br /> i <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analyals:(Signature) DatefTime <br /> Dispatched by: (Signature) Date/Time Received to Laboratory by: Dalefrime <br /> Method of Shipment: /� � Laboratory �T'b <br /> Special Instructions: I hereby ulhoriz the perforrnanca of the above Indicated work., <br /> _ '� ,.. _ __ ... .� .tarP Chi', i!,•, i .. fil, , � ,� ' <br />