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i • y � <br /> j Advanced <br /> CHAIN OF CUSTODAECORD <br /> --- GeoEnvironmental Inc. Date -z Page z of <br /> 837 Shaw Road-Stockton, California- 95215- (209)467-1006- Fax (209)467-1118 r} <br /> Client Gve ProjjeectManager Tests Required <br /> 1= 6 <br /> Phone Number <br /> LZ C) <br /> Samplers: (Signatu ) � Invoice: <br /> AGE <br /> Project Name ( 5, Client ❑ <br /> Sample Type <br /> Sample Location Date TimeSolid No. of Nates <br /> Number Description Water Air Conts. 'J <br /> Comp. Grab. <br /> Joh <br /> kA.ii tci <br /> it U I <br /> e ingws a y: , ature) ec rye y: rgnature DateIT.'me <br /> Relinquished by: (Signature) Received by: (Signature) Date/Time <br /> Relinquished by: (signature) Received by Mobile Laboratory for field analysis: (Signature) DatelTime <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by - J Date/T' e <br /> }( <br /> Method of Shipment: Labor or1liame <br /> Special instructions: I hereby horize th ormance of the above indicated work. <br />