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t <br /> CHAIN OF CUSTODY RECORD <br /> Advanced <br /> R <br /> =_ GeoEnvironmental, Inc. � { ,�, Q�. Date r o Page of 1 <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(204467-11,118 <br /> Client Proje9t M ager Tests Required <br /> V, s_ . v <br /> pe tuberle s: (Signature) invoice: <br /> AGE <br /> Project Name i Client ❑ <br /> Sample Type ✓ l. .:: <br /> Sample Location Noof <br /> Date Time Water Solid . -69679 <br /> Number Description Air Conts. i } <br /> comp. (arab.AAkJ <br /> cc kl <br /> 61 LJ 416 Ina <br /> e inqu s y: ig atur } Received y: (SignatureDate/Time <br /> Relinqu shed by: (Signature} ed by: (Signature) 4` it)atelTime <br /> Relinquished by: (Signature) U" fiecei;i by µobiE - 6r field analysis: (Signature) DatelTrme <br /> i G:D S �k '-itiT CONTAINERS <br /> Dispatched by: (Signature) Daterrime Received for Laboratory by: ��_ ` ale/Time <br /> ora or Name <br /> Method of Shipment: <br /> Special Instructions: I hereby au ixe the - formance of the above indlcat work. <br /> i <br />