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-� ti• l� <br /> ( Advanced CHAIN OF CUSTODY ( CORD <br /> � r <br /> GeoEnv�ironmental, Inc. Date ? 7 Page <br /> 4005 Notch Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> Client -, Project'Manager, Tests Required <br /> B cC. <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> Project Name l ( - AGE ❑ <br /> Client 21' <br /> Sample Location Sample Type <br /> Number Description <br /> Date Time Water Air Solid No. Of Conts. Notes <br /> Comp. Grab. <br /> .7Voto <br /> - — <br /> 7T <br /> ellnqui ad by: (Signa r eceive y: tgn lure Date/Time <br /> Relin i n \ <br /> Ruishe. b Y� (Signature)) Rs�eive3 by: (Signature) vrr Date(Tlme <br /> OTHER <br /> Relinquished by. (Signature) Received by Mobile Laboratory for field analysis: (Signature) ✓ Pn[[[t1�fA= ,�I 0 lne <br /> ICUS rlC�3G+*w r J- <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: V Daterr1rhe <br /> �4-AD SPACF ABS <br /> Method of Shipment: Laboratory ame /1 <br /> a QJS-_�,Pyt <br /> Special Instructions: 1 hereby authorlze the performance of the above Indicated work. <br /> Vim'�,`r• v� <br /> --------------------------------------------------------------------------- <br />