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M M IMI M <br /> CHAIN OF CUSTODIAECORD <br /> Advanced Dig Z l (b Page 'of <br /> GeoEnvironmental, Inc. <br /> 837 Shaw Road-Stockton California-95215-(249)467-1006- Fax (209)467-1118 + m <br /> Client ; Project Wlana�[ Tests Required <br /> ct t.. i <br /> Phone Number <br /> Samplers (Signature) invoice <br /> �- <br /> AGEEy <br /> Project Name �� .. � Client ❑ <br /> Sample Location Sample Type i <br /> P Date Time Water Solid No of �� ` Notes <br /> Number Description comp arab AIT C° s <br /> a 1 ' '4 <br /> Date/Trine <br /> e in s e y ( Ie) eceave y �gnsture �� � <br /> Datel7ime <br /> Relinquished by (signature) Received by (Signature) <br /> Relinquaehed by {Signature) Received by Mobile Laboratory for lieid analysis (Signature) DatelT'n18 <br /> Dispatched by (Signature) DatefTirne Received for t-aboratory by DatefTime <br /> Method of Shipment Lab glato ame <br /> Spacial Instructions l hersbreauthorize the performance of the above Indicated work <br />