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>• � _ � � � � � � � � � lfffifffff� �. <br /> • CHAIN OF CUSTODY RECORD <br /> � Advanced ' <br /> - _ Date G O Page —L- of <br /> GeoEnvironmental, Inc. <br /> 837 Shaw Road - Stockton, California 95215- (209)467-1006- Fax(209)467-1118 TO <br /> Client Protect Manager Tests Requfr <br /> Phone Number <br /> Z09 J�627 " Invoice <br /> Sam rs (Signature) 4. <br /> ,o AGE 4K <br /> Project Name �� f��" kr� Client ❑ <br /> nf, pr.�o w�Q fi <br /> Sample Location Sample Type No of N Notes <br /> Number Description Date Time comWateorrab Air Sajid Conts <br /> ° ��o9a1 J�3� JCC 3 x �( <br /> W <br /> 110901 3 x <br /> &/0901 yasdl 14(30 3 xJR1 7. A <br /> x <br /> oya9o/ oyo9ol 13zS` '� 3 't <br /> 009011 &/-0901 /z 3:S- <br /> oy�yo I /-09-01 ��30 3 oc <br /> n Cr me <br /> e in j-413 e y nature eceive y (Signature) <br /> L ate/Time <br /> R wished y ign e) Received by (Signature) <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) J� �� Date/Time <br /> Dispatched by (Signature) <br /> DatelTime Received for Laboratory by �J DalelTime <br /> Laboratory Name <br /> Method of Shipment /AL <br /> I hereby authorize the performance of the above indicated work , <br /> Special instructions <br />