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r r r r r c r r r r r r r r r r r r r <br /> o3 - oL`7 <br /> Advanced CHAIN OF CUSTODY RECORD <br /> --- GeoEnviron mental, Inc. pate Page Z�L of� _ <br /> 837 Shaw Road- Stockton, California- 95215- (209)467-1006 - Fax (209)467-1118 <br /> Client } Project Manager <br /> • �1 I L r ncgt `c4 A � Mabis Required <br /> ✓t, <br /> Phone Number <br /> Samplers: (Signature) fJ Invoice: <br /> Project Name /�,� � t <br /> _ AGE <br /> f� Q V7 Client <br /> Sample Location Sample Type No. of <br /> Date Time Water Solid Notes <br /> Number Description Comp. Grab. Air Conts. <br /> � w <br /> elinqui y: Signat e) eceive y: Signature ate/Time <br /> *'�19d9' <br /> Resin ui hed b Si nature � D <br /> q y: { 9 ) Received by: (Signature) Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Date/Time <br /> y.•cam� <br /> Method of Shipment: Laboratory Name <br /> ( � t 4441 ! <br /> Special Instructions: I hereby authorize the performance of the above indicated work. <br /> t <br />