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�r■ ar = M M MM = = ,= = = <br /> *Advanced CHAIN OF CUSTODY WORD <br /> GeoEnvironmental, Inc. Date ! Page 3— of-sl— <br /> l=` of Northern Califomta <br /> 1803 West March Lane Suite A-Stockton California 95207-(209)9560264 Fax(209)956.0740 <br /> Client T <br /> Project Manager <br /> a E� Lam_ Tests Required <br /> Phone Number ,I <br /> L7 <br /> Samplers (Signature) ` Invoice <br /> Project Namef.( r� AGEY <br /> �� Client ❑ <br /> Sample Location Sample Type No of <br /> Number Description Date Time Water Air Solid Conts Notes <br /> Comp Grab <br /> Relinquished y (Signature ei o y ignatu 1 q� Date/Time <br /> Relinquished by (Signa ure) Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Datef ime <br /> Dispatched by (Signature) Dale/Time Recen for Laboratory by Date(Time <br /> Methodpment Laboratory Name <br /> n <br /> Special Instructions I hereby authorize the performance of the above indicated work <br />