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CHAIN OF CUSTODY RECORD <br /> Advanced Date Page of�� <br /> GeoEnvironmental, Inc. <br /> 637 Shaw Road-Stockton, California- 95215- (209)467-1006-Fax (209) 467-111a G ` <br /> Client � � � f,+.r Project N!T��mer � tests Required <br /> Phone Number <br /> Samplers (Signature) +".} Invoice <br /> Project Name ' C(GEtt <br /> r` <br /> Sample Type � <br /> Sample Location No of j�' <br /> Number Description Date Time Water Air Sal}ci Conts Nates <br /> p Comp Grab <br /> i l <br /> 4/ l <br /> mh :� �G� 3 5 36 <br /> e in s e y ure) eceive y ignature 0 [Time <br /> Relinquished by (Signature) Received by (Signature) Date[Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) �' Datefrime <br /> Dispatched by (Signature) Datef ime Received for Labory DatelTime <br /> Method of Shipment fn <br /> Labor ry <br /> <. e-C'_/1 <br /> Special Instructions f hereby uthorize the performance of the above indicated work 1 <br />