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� � � � � � � � � � � � � � 1• l• l� 1• l• <br /> j Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc <br /> Date �� J T page � of <br /> 4005 North Wilson Way Stockton California-95205-(209)467 1006-Fax(209)467-1118 f awl sz A <br /> Client �C Project Manager I <br /> 1?1 � Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> Project Name AGE ❑ <br /> AIM- � Client <br /> Sample Location Date ��ittte Sample Type Water Solid No of �Q nfnlpc <br /> Number Description 3� Comp Grab Air Conts 98356 <br /> 98357 <br /> 98358 <br /> 98359 <br /> Be�gm;90 <br /> ec rve y r� e ��_�Q_[j� � Dale(Time <br /> w Tr M,9(5 I' <br /> Relinquished by (Srgnat R ived by (Sign ure) r Dala(Trme <br /> Relinquished by (Signature) Received by Mobile Laboratory for held analysis (Signature) ill!! DateJTime <br /> Dispatched by (Signature) Date/Time Received for Laboratory by Date rime <br /> Method of Shipment {�. �zlg � 'D r_ L.borat r am <br /> t— <br /> + <br /> 0C.G aC 1f n r( e- QU I� f J�i�a-�1� y <br /> Special instructions Y�AS Uqr] I��E�AIS OTHEfl I hereby authorize the performance of the above indicated work <br /> GG00�rtA;F}1T40; APPROPRIATECONV <br /> I <br />