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j Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Dater s _L_ of <br /> \.y � 837 Shaw Road- Stockton, California - 95215 - (209) 467-1006 - Fax (209) 467-1116 1 2 C) <br /> Client pp Project Manager Tests Required <br /> Pi f vt <br /> Phone N mber <br /> Samplers: (Signature) j9z� �J Invoice: <br /> ? J AGE <br /> Project Name Pf <br /> U� �\ Client <br /> Sample Tyrpe No. of x'17 <br /> Sample Location Date Time Water Solid �0 141* Notes <br /> Number Description Camp. Grab. Alr Conts. <br /> �j - � ►« fl I X X X <br /> 613 <br /> 13i� � jo 12Z'y �` I <br /> Dale/Time <br /> I qws e ( i r ecerve y: rgnature <br /> P -3c, qJ 33'v <br /> Date(Tim <br /> Received by: (Signature} <"— A r T s <br /> elinquish d by: igna ute) 1 <br /> Relinquished by: (Signature) <br /> Received by Mobile Laboratory lot field analysis: (Signature) Date/Time <br /> Dats/Time Racery ud for LaboratorYby: Datef ims <br /> Dispatched by: (Signature) f _ <br /> Lab,04tory Name _T7�t'- <br /> I_�N. <br /> J <br /> Method of Shipment: / ' <br /> ' <br /> 1 hereby authorize the Pori_ mance of the above Indicated work. <br /> Special Instructions: _ �°' <br />