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l� <br /> Advanced - CHAIN OF CUSTODY RECORD <br /> � �- ^ Page �__ of�-..---- <br /> GeoEnvironmental, Inc. Date <br /> of Northern Calfforn+a <br /> 1803 West March Lane, Suite A-Stockton, California 95207-(209)956-0264 Fax( )956-0700 <br /> Client < <br /> Pro ect Manager Tests Required <br /> -�� ��� A � � <br /> Phone Number <br /> Y <br /> Samplers (Signature) Invoice <br /> AGE �d' <br /> Project Name ! 4 Client ❑ <br /> Sample Location Date Time Water Sample Type Solid No of 1D Notes <br /> Number Description Comp ran Air Cants <br /> e ingws ed by (Signature) Received by ignature Date/Time <br /> ehnquished b ignalure) Recery by (Signature) Date/Time <br /> er <br /> Relinquished by (Signature) Received by Mobile Laboratory br field analysis (Signature) Date/Time <br /> Dispatched by (Signature) 44 Date/TimeRecei d for Laborat ry Date/Time <br /> Method of Shipment aboratory Nam <br /> Special Instructions � <br /> I hereby authorize the pedormane of the above rndicated work <br /> / E� <br />