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np4-- <br /> Advanced CHNIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. <br /> Date �� �-a� Page of <br /> 837 Shaw Road - Stockton, California-95215- (209)467-1006- Fax (209)467-1118 <br /> Client 1�� Project Manager ✓��Tests Required <br /> an V"O' 1 <br /> Phone Number <br /> (a01 <br /> Samplers: (Signature) Invoice: <br /> n,A� AGE <br /> Project Name I� S — ��( � Y v 9 Client <br /> aaa Type Sample Location Sample <br /> Date Time Water Solid No. of V Notes <br /> Number Description Comp. Grab. Air Conts. Q <br /> - tb 3 loacl <br /> - <br /> ab Gfi a O ' 41091 k d <br /> ILA 3s I I J <br /> 1 Inz�ld <br /> Relinquished y: ( ignature) rcei a y: ignature _ Dete ime <br /> Re quished by: ig t e) Received by: (Signature) J� Dat /Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) e I /i Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory,by: Iw FV\R-• Date/Time <br /> Method of Shipment: boralo Name <br /> n ~ <br /> �� SO Tec V� <br /> Special Instructions: I hereby authorize the performance of the above Indicated work. <br />