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• <br /> J • <br /> Advanced CHAIN OF CUSTODY RECORD <br /> -- GeoEnvironmenta , Inc Date 9 �` Page 1. of <br /> 837 Shaw Road - Stockton, California- 85215 - (209) 467-1006 Fax (20y) 461-111 a <br /> Client "� C � - -t � j a Project Manager � Tests Required <br /> Phone Number �y <br /> Samplers (Signature) Invoice <br /> Project Namef J AGE <br /> Client ❑ <br /> Sample Type <br /> Sample Location Date Time Solid NO of ��� <br /> Number Description Water Air Conts Notes <br /> r <br /> M�'Q Ilse <br /> Cutup Grab <br /> r+qurshad y i s} aceivegnat f Dale/Time <br /> Re, gwshed by (Signature) ✓ Received by (SigttQlure) Dale/Time <br /> Relinquished by (Signature) READSPACEA.Ii5IiNl' aboratory for held anidywii w Data/Time <br /> bECHLOR1NA12D El+i RESERVED IN L AHL _ <br /> Dispatched by (Signature) 'CIM DRUM mo Jfascarvad for Lxiboratury by <br /> Date/Time <br /> Method of Shipment Laboratory Narne _ <br /> Special Insiruawns r( `` I h6ra authorize the pertormanc 1 tits above Indicated work <br />