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� Advanced <br /> CHAIN 9FUSTODY RECORD <br /> Date Page --L Of <br /> GeoEnvironmental, Inc. 0205744/1 <br /> 837 Shaw Road - Stockton, California-95215- (209)467-1006 - Fax(209)467-1118 <br /> Client Pro�ct nager <br /> �7 s Required <br /> Dilione Klumber <br /> Zzf- <br /> ` �.-� C} Cr4 rs (Si nature) 4 Invoice <br /> Project Name AGE.cr ! Client ❑ <br /> t] <br /> Sample Type <br /> Sample Location Date Time Water Solid No of Notes <br /> Number Description Comp Grab Air Conts <br /> d _ <br /> �3 3©-- a <br /> e inqui y i t ey Receivedy gnature D te/Time <br /> o !r D <br /> Relinquished by (Signature) V Received by (Signature) Date me <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) kyr, Datef'rime <br /> I Y <br /> Dispatched by (Signature) Datefrime Receive for Tabora pete/Time r <br /> Method of Shipment aborato Na <br /> lied <br /> Special Instructions 1 hereby authorize th performance of the above indicated work j <br /> W 1 >`!l i1�9 <br /> i`.1 <br />