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i i i � i i tl, t!• i i i i tib titii i � � <br /> Advanced O a - 17'1 CHAIN OF CUSTODY, lECORD <br /> -- GeoEnyironmental, Inc. Dated '� Page `� of <br /> 837 Shaw Road-Stockton, California-95215-(209)467-1006-1=ax(209)467-1118 <br /> Client , ? Project Manager <br /> Tests Required <br /> L :LJ <br /> Phone Ntuber <br /> �� <br /> Samplers (Signature) Invoice <br /> Project NameL <br /> ��.�c� Ar n , � AGS <br /> T-�'x Chem <br /> Sample Location Sample Type No of <br /> Date Time Water Solid Notes <br /> Number Description comp Grab Air Conts. <br /> Lo <br /> �4 <br /> 16610 <br /> A"4J 01-0 <br /> e s e i slurs Received y (Signature) 7/s <br /> o <br /> Relinquished by (Signature) Received by (Signature) A i Oate/T me <br /> s , <br /> F. <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time f(ecaived for Laboratory by Date/Tim <br /> Method of Ship enI Laboratory Name <br /> GIP-Al Tom! <br /> Special Instructions I hereby a oNze the perfor rice of the above Indicated work <br /> l <br />