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0 Advanced CHAIN F CUSTOD RECORD <br /> � <br /> Date Page L_ of <br /> --- GeoEnvironmental, Inc. 7� �`C.. <br /> 4005 North Wilson Way-Stockton,Calitomia-95205-(209)467-1006-Fax(209)467-1118 <br /> Client Project Mger <br /> Tests Req <br /> uir d <br /> d <br /> 0. Fap?a <br /> zPh Number <br /> e s: gnature) Invoice; <br /> Project Name Client E] <br /> Sample Type <br /> Sample Location No. of <br /> Date Time Water Solid Notes <br /> Number Description Comp- Grab. Air Conts.�� i43164 <br /> Iola- �C 43165 <br /> .. .4 a <br /> M1V%w IL <br /> Vft1w V3 <br /> doll Nz <br /> 1w n�1< 0 <br /> e m i e (Si ature aceive y: Ignature Date/Time <br /> Relin wished b (Signature Received by: (Signature) DalefTims <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Ret ivoo far Laborat ry,ky: Date/Time <br /> Method of Shipment' Laboratory m <br /> Special Instructions: I,hereby uthori the rf rmanc of the above indicated work. <br /> -;1,eA C / <br /> ��3_ ���V <br />