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( Advanced CHAKOF CUSTODY RECORD <br /> GeoEnvironmentAl, Inc Dace Page <br /> 837 Shaw Road Stockton, California 95215-(209)467-1006- Fax (209)467-1118 <br /> Client <br /> Project Marner <br /> Y <br /> Tests Required <br /> P ne umber <br /> i <br /> Sa rs (Signature Invoice <br /> Project Narne � <br /> AGE <br /> Sample Location Sample Type I Client ❑ <br /> No of <br /> Number Description Date Time Water Air Solid Colts Notes <br /> Comp (arab <br /> 3 �L3 Z1 �- <br /> v3e! L <br /> t <br /> I <br /> e n uis a <br /> Y ( gn urs) I RReceived by' tgnature <br /> ate(Ttme <br /> Re irtqutshed by (Signature) /� <br /> Received by (Signature) t:�l..' <br /> Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysts (Signature) <br /> DatelTtme <br /> Dispatched by (Signature) Date/Iime HeMelvatLaboratory by <br /> Date/Time <br /> i <br /> Method of Shipment Lab at e <br /> Special Instructions <br /> Ou,"lu,jr � A -- <br /> I hereby th rile the aria me nce oft above indicated work <br /> r` <br />