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:a • <br /> ( Advanced CHAIN OF CUSTODY RECORD <br /> --- <br /> "y GeoEnvironmental, Inc. Dace Page / of / <br /> 637 Shaw Road-Stockton, California-95215- (209) 467-1006- Fax (209) 467-1118 w <br /> Client Pro ec ,� c.1�.kt Manager Tests Required <br /> Phone Number <br /> �6-9 IOC16 <br /> Samplers: (Signature) �� Invoice: <br /> Project Name � y� j_ � AGE <br /> `'�' ,�a Client ❑ <br /> Sample Location Sample Type <br /> of <br /> Number Description Date Time Water Solid No. s. Notes <br /> Comp. Grab. Alr COnt .�j <br /> Ho ash o3 f a5a -XI � Xl <br /> M t");45-iw !tel W L Iain J j(r <br /> 'A ; <br /> wy .a 4 <br /> 1u w 5 3 0• yin b" f 1��D ✓` � J'� <br /> o,,P :5'30c3 E-/,J I <br /> elin is a y: ignature} ace va y: rgnature t]atelTime <br /> S Q 1E <br /> a nc3 <br /> Re inquished by: (Signure) Received by: (Signature) Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) DatelTime <br /> Dispatched by: (Signature) Date/Time Received for Labora b : Dale/Time <br /> Method of Shipment: 'a or m r <br /> Special instructions: I here b uthorize the <br /> performance of the above indicated work. <br />