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�F Ll <br /> Advanced CHAIN 9F USTODY RECORD <br /> GeoEnvironment Date 4 �� � of� <br /> „ al, Inc. Page <br /> 837 Shaw Road - Stockton, California 95215 - (209) 467-1006 - Fax (209) 467-1118 <br /> Client Project Manager <br /> Tests Required <br /> Tone Number <br /> 96 <br /> U? C <br /> Sampl,rs (Signature) Invoice <br /> Project Name AGE <br /> 1' <br /> k&V ro-v''\ Client ❑ <br /> Sample Location Sample Type No of <br /> Number Description date Time Water Air Solid Conts Notes <br /> Comp Grab <br /> J 0- 31a3ILA <br /> AJT <br /> -N6,qui i y gnature) ec ve y a; <br /> Dete rme <br /> Relinq ed by (Sign tut Race ry Signature) 'r D te(Ttme <br /> Rellnqu d (Signature} <br /> �� Recery by a Lab tory or f1 fi�anal si^ (5ignr+ re) �l7ate�Ttm�1! <br /> Orspatched by ( ignature) Date/Time Received for Laboratory by <br /> ate ime <br /> Method of Shipment Laborat9�__O e <br /> r• <br /> �. ,^ f <br /> Special instructions f her thorize the perfor ante of the above Indicated work <br />