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• • ! <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. <br /> Date _ Page �_ of 4_ <br /> 837 Shaw Road Stockton, California-95215- (209)467-1006-Fax (209)467-1118 <br /> Client (. ` -- Project IManager L1 <br /> Tests Required <br /> Phone Number <br /> 2 0 � c- ` <br /> Samplers (Signature) Invoice <br /> Project Name ��, ,aE t �, AGE <br /> Client ❑ <br /> Sample Location Sample Type <br /> Date Time Water Solid No of r' Notes <br /> Number Description Comp (arab Air Cents <br /> AA �qqq r <br /> r <br /> J f <br /> e Inquished by ignatureReceived y ignal;ure ar Oate/Time <br /> Re inquwshed by (Signature) Received by (Signature) <br /> DatslTtme <br /> Relinquished by (Signature) Received by Mobile Laboratory for held analysts (Signature) r Date(Ttms <br /> 7,f <br /> Dispatched by (Signature) Date/Time Received for aboratoryb ` Date(Time G 'J-t <br /> Ji <br /> Method of Shipment Laboratory Name <br /> Special Instructions I hereby authorize the performance of the above indicated work <br />