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• • • - <br /> � ? Advanced CHAIN OF CUSTODY RECORD - <br /> _ GeoEnvironmental, Inc. Date �� B� Page .. Of <br /> 837 Shaw Road-Stockton California-95245- 2 - <br /> ( 03J 4fi7-1 o0S- Fax(209)b67 1148 0 <br /> Client Project Man a <br /> Tests Required <br /> P hone N mb ,&C <br /> er <br /> t Z 7--- <br /> amplers (Signature) invoice <br /> Project Name AGE <br /> &k"e r Client ❑ <br /> � <br /> Sample Location Date Time Sample Type Solid No o Notes <br /> Number Description Water Air Conts <br /> Comp arab <br /> e inquis e y igneture} Received y (Signature) telT e <br /> Relinquished b (SEgnat a) Received by (Signature) DatelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for held analysis (Signature) Datel7ime <br /> Dispatched by (Signature) Date/Time Received for Laboratory ?-*L q <br /> Method of Shipment L ratory Name <br /> Gi. tl <br /> Special lnstructwnsV rye p� fll 1 hereby authorize the performance of the above Indicated work <br />