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CHAIN 9171 CUSTODY RECORD <br /> ' Advanced Date Page —/— of <br /> --- GeoEnvironmental, Inc. <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467.1006-Fax(209)467 1118 <br /> Client Pro' Manager Tests Required <br /> Phone Nu er <br /> Sampler : (Si Lure) Invoice: <br /> f AG� <br /> Project Name //2/z <br /> 13u${-�1 tLl) / `GSL f Client ❑ <br /> Sample Type , <br /> Sample Location Date Time Water Solid No. of Notes <br /> Number Description Comp. Grab, Air Conts. <br /> 4���d <br /> e r ui <br /> Reli qui <br /> DatelTime <br /> y: Receivedy: (Signature <br /> cw <br /> shed <br /> by: 'Received <br /> by: (Signature) ` ` ��� Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> I <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Date/Time <br /> Method of Shipmenr: Laboratory Ilam <br /> Special Instructions: I hereby authorize th performance of the above indicated work. <br />