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i i • <br /> npAdvanced CHAIN OF CUSTODY RECORD <br /> GeoEnvxronmental, Inc. Date Page '�`� �- <br /> 837 Shaw Road-Stockton, California- 95215- (209)467-1006 - Fax (209) 467-1118 f1 —J R (� <br /> Client � . v�� A&-1i6-1c!-o— Pr-o e Mena r Tests Required <br /> u [ t' <br /> Phone Number <br /> A?`67 1&36 <br /> Samplers (Signature) Invoice <br /> r <br /> Project Name {ej� AGE <br /> Client ❑ <br /> Sample LocationSample Type <br /> Date Time Comp Grab Air Solid Contsf / �� Notes <br /> Number Description <br /> r 4.33id <br /> "I/AI <br /> ) Will C �' K-+-tom; l �� <br /> Heir uis e yure Receive y ignature Datw/Time <br /> Relinquished by (Signature) Received by (Signature) <br /> Datelof Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date[Time <br /> r <br /> 5�� <br /> Dispatched by (Signature) Date/Time Received for aboratory 1by V " � Dats/ Ie <br /> „ i-I I � � <br /> �, <br /> ~Method of Shipment La o�l ame <br /> Special Instructions � <br /> { hereby authorize the performance of the above Indicated work <br />