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� I• � � 1• � � � +' � � fl• � �� � �� fi♦ i� >1• <br /> Advanced CHAIN OF CUSTODY RECORD <br /> _= GeoEnvironmental, inc. Date c3 Page 3 of <br /> 837 Shaw Road- Stockton, California- 95215 - (209)467-1006- Fax (209)467-1118 <br /> Client Project Manager <br /> o � Tests Required <br /> Phone Number <br /> Samplers (Sign re) �' Invoice. <br /> Project Name AGE B <br /> + CI)ertt ❑ <br /> Sample Type <br /> Sample Location Date Time Water Solid No of gT Notes <br /> Number Description CamAir Conts r <br /> p Grab <br /> - r <br /> 36s2 1705 3 <br /> Q 5 z3 d6�� 3 <br /> dos s z� 1365 � <br /> 4 S <br /> 3 S 2,3 of 1SSo <br /> Fiat' q ' bad by ignature) ece ve y ignalure DaterT me <br /> 547-03 <br /> �.3C <br /> quashed by (Signature) Received by (Signature) Daterrime <br /> Relinquished by (Signature) Received by Mobile Laboratory for hold analysis (Signature) DaterTime <br /> Dispatched by (Signature) Date/Time Receive r Laboref ory by atefrimmee /yy� <br /> Method of Shipment Laboratory Name <br /> LAI o Ver , -�- a I 7-e-cA <br /> Special Instructions I hereby authorize the performance of the above indicated work <br />