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� � I♦ � � I♦ � � >• E• �■� �� t� t�lwlle �� tt� w. <br /> j Advanced <br /> CHAIN OF CUSTOD RECORD <br /> GeoEnvironmental, Inc. Date Q pare 3 of <br /> 837 Shaw Road-Stockton, California-95215- (209)467-1006- Fax(209)467-1118 <br /> Client o�ect Manager / 1 <br /> E ru Y I V� �"(-J Y L i� 1 Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> Protect Name �'� Client ❑ <br /> Sample Location Solid Sample Type No of <br /> Number Description Date Time (Nater Air Conts �� Notes <br /> Comp Grab <br /> xxi <br /> Relinquished natureReceived y (Signature) atelTime <br /> 9103 /60b <br /> quished b (Signature) Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) i •-1+" Date/Time <br /> Dispatched by (Signature) Datefrrme Received for Laboratory by Date rime <br /> Method of ShipmentU,4Dv� Zl ' f Labo tory Name <br /> Special Instructions hereby authorize the performance of the above indicated work <br />