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�-� _� <br /> [ Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc Date ' Page <br /> 837 Shaw Road-Stockton, California-95215 - (209)467-1006- Fax(209)467-1118 <br /> Client LV S L Pro ect Manager - <br /> Tests Required <br /> 'zi\C - Phone Number <br /> t <br /> Samplers (Signature) Invoice <br /> Project Name x, e ���� C ✓� ' taL bit-- AGE ❑ <br /> Client <br /> Sample Location Sample Type <br /> Time Date Tie No of <br /> Number Description Water Air Solid Con Notes <br /> Comp arab <br /> dGOOD C NDO IT'Io1�,—^..,.,. APPR RIAT$ <br /> 1 EAD 5P C -"CQ�m +nrr� n <br /> DECHLORINATED IN LAB,„.,,,PnS VIgb IN 1,L� v <br /> iALED <br /> va 0AII 011€aa k <br /> Rel' h db ignatur Heceived by <br /> l(W � rg e `�/')r 16 .ol fAh 1 ^ t]ats/Time <br /> Relinquished by (Signature) Received by `(1Signature) ~{ � Y ii'! �r 7 Date(Time <br /> Relinquished by (Signature) Received by Mobile Laboratory tot field enaiys4s (Signature) Date Time <br /> Dispatched by (Signature) Date/Time Received for Laboratory by <br /> Datell ime <br /> Method of Shipment L�y.� Labor Tory Na // <br /> Special Instructions I hereby authorize the performance of the above Indicated work <br />