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f♦ i♦ i♦ ! i• i♦ ! ! i• � ! ! ilii! i � � <br /> CHAIN OF CUSTODRECORD <br /> Advanced Date LL Page Z <br /> " GeoEnvironmental, Inc. <br /> 837 Shaw Road-Stockton, California-85215- (209)467-1006- Fax (209)467-1118 <br /> Client � PrFZ7 nager <br /> VA �Aa'm Tests Required <br /> C <br /> one mber <br /> f,,mplers (Signature) r Invoice. <br /> Project Name ak AGE <br /> Client ❑ <br /> Sample Location Sample Type No of <br /> Number Descnption pate Time Water IAir Solid Conts Notes <br /> Comp Grab <br /> _ L4 XIMIX <br /> t.W <br /> 3 I YX XX I I <br /> 4a <br /> a7 NUJ 7 Io06 <br /> e inqu s e . ature ace ve y ignature) ate/Ti e <br /> S <br /> Rel.n �b, ature Received by (Signature) Data .me <br /> Relinquished by (Signature) Received by Mobile Laboratory for held analysis (Signature) DatelTime <br /> Dispatched by (Signature) Data/Time Received for Laboratory by Date/Timq <br /> Method of Shipment Laboratory Wtine <br /> L f <br /> _C f I <br /> Special tnsuuctions �l � / <br /> I hereby authorize the performance of the above indicated work <br />