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Advanced CHAIN OF CUSTODY - r1ECORD <br /> Date — f 1' Page of <br /> GeoEnvzronmental, Inc. <br /> /f 4005 North Wilson Way-Stockton, California-95205-(209)467-1006-Fax(209)467-1118 <br /> _ 12� - � � <br /> Client '. Project <br /> /Mana er / Tests Required <br /> Phone Number <br /> L <br /> Samplers: (Signature) Invoice: <br /> Project Name ` Client ❑ <br /> Sample Location Sample Type <br /> Date Time Water Solid No. of Notes <br /> Number Description Air Conts. <br /> Comp. Grab. <br /> D i b 3� i <br /> elirtt[vrsetLyi(Signature) Recerved by: ( ignature) <br /> ^ Date)'rime <br /> Relinquished by: (S-rgnature) Received by: (Signature) V l �] Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Date/Timo Received for Laboratory by: D e/Time <br /> Method of Shipment: Labofaiory Name <br /> Special Instructions: I hereby authorize the performance of the above indicated work. <br />