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i <br /> is <br /> Advanced o--� <br /> � � CHAtN OF CUSTOD RECORD <br /> Date page r' of <br /> GeoEnvironmental, Inc. <br /> 837 Shaw Road-Stockton,California-95215- (209)467-1006- Fax(209)467-1118 <br /> Clienttins Prc manageii., <br /> Y A"� Tests Required <br /> 1 <br /> Phone Nu r <br /> <� &-vt i <br /> Sa lers Signature) L� � Invoice* <br /> Protect Name C6 � �,��jS�� <br /> { <br /> AGE,E'' <br /> client ❑ <br /> Sample Location Sample Type No of <br /> Number Description Date Time Water Air SolidNoNotes <br /> Comp Grab <br /> '3-o na, <br /> qd`I f dz'o <br /> t)ate/Tima <br /> e tnqui 4byignatufey- <br /> aceiva y ignalure G l r2l kWRelinqutsh dReceived by (Signature) DatsM e <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatelTime <br /> Dispatched by (Signature) Date/Time Received for Laboratory Dote/Time <br /> _ <br /> ?- <br /> Method <br /> Method of Shipme orato Name <br /> ?` A L Cts <br /> Special Instruction � ff r I h thorize t �erlmance of the above Indicated work <br />