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• i ir <br /> Advanced CHAIN OF CUSTODY RECORD <br /> . ?� .� <br /> GeoEnvironmental, Inc. DSS <br /> Date Page - o <br /> 837 Shaw Road- Stockton,California-95215-(209)467-1006-Fax(209)467-1118 j <br /> Protect Man g r <br /> Client , 1 s` <br /> ,tie ' p iltUTests Required', i <br /> Phone Number s <br /> 3l <br /> Samplers (Signature) � 'in Ice <br /> jiAGE <br /> Protect Name { A&a"hk , <br /> 'Ghent <br /> Sample Type <br /> Sample LocationSample <br /> Time Water Salld No of Nott <br /> Number Description Air Corns J <br /> Comp Grab <br /> 01 <br /> f�} <br /> t}}} <br /> Rail e y l a e} ecerve y Igna ure Datj/ ;( <br /> I � {1 ;c <br /> rl s <br /> Relinquished by (Signature) Received by (Signature) Date/Tims <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Dalefrtme <br /> Dispatched by (Signature) Dole/Time Recei a or aboratgry by DatetTlme <br /> r tl <br /> Method o1 Shipment ,1 GLtY fjr<4� L61 hl� ►lE t}�r1} Vele Xy- Labors �N7 1e <br /> yNp� � <br /> Special Instructions ICEIta I hereby authorize the performance at the above Indicatedylork <br /> GOOD CfOi 1DiT id1 r.....�..` AO�R[A7a l r <br /> RECD SEALED&INTACT VIA D"crff ot:ifvnrt?n� 0&0_I WffPJA amt 17 <br /> PREBERVAF70N <br />