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i i• i i i i i i i tffi i i i i i i t� ti <br /> Advanced CHAIN OF CUSTODY RECORD <br /> -- GeoEnvironmentai, Inc , Date Pose of <br /> 837 Shaw Aoad- Stockton,California- 95215 - (209) 467-1006 - Fax (209)467-1118 <br /> Client P onager Tests Required <br /> PJ6ne NIS ber <br /> mp ature) Invoice <br /> Project Name AGE <br /> Client [] <br /> Sample Jocation Sample Type <br /> No of <br /> Number Description pate Time Water Solid Notes <br /> comp (arab Air Conts <br /> N , <br /> e rnqs y r at aReceived y isignaturey telT[me <br /> Rehngws ed by (Sbnature) Received by (Signature) ob <br /> ate/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) , Date/Time <br /> Dispatched by (Signature) DatelTime Received for Laboratory y Oate/Tim�e <br /> L <br /> Method of Shipment O&P <br /> Laboratory GNaamm—6L! ' ! 7� <br /> Special Instructions I hereby uthorl a the p f rma C of the above indicated work <br /> A 1 <br /> V r <br />