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z CHAIN OF CUSTODY RECORD' <br /> A , -Advanced` - _ - <br /> • .. Date. -.I Page � of <br /> GeoEnyironmental, Inc. <br /> 5. 4005 North Wilson Way-Stockton,California--.95205'-(209)467.1006-Fax(209)467-111$ <br /> Project Manager�� <br /> Client ) t Tests Required ,- <br /> - <br /> k Phone Number <br /> Samplers: (Signature) : Invoice:, <br /> \ , AGI, <br /> Project Name- . <br /> Client ❑" .. <br /> Sample Type ' <br /> Sample Location Solid. V No. of _ .rte f� Notes <br /> Date Time Water <br /> Number Description comp. . crab, Air Conts. <br /> It+IV11-1 "j� �� c 1 c f� N, M <<1-� y3 14 x <br /> kJ <br /> T' ` - F 'r k Q 1 ( ` Y •r - <br /> rnquis y: rgnature ecerve y:a (Signature) ._ 00-A <br /> � Dsle/Time. <br /> tv <br /> Relinquished by: (Signature) " Received by: (Signature) _ Date/Tim <br /> Relinquished by: (Signature) Received by Mobile Laboratory tortieid analysis: (Signature) _ Date/Time <br /> Dispatched by: (Signature) dale/Time Received for laboratory by: _ DatelTime <br /> Method of Shipment: . Laboratory.Name /rr <br /> - <br /> Special Instructions: . I hereby authorize the performance,of the above Indicated work: <br />