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j Advanced CHAIN OF CUSTODY RECORD _ <br /> Date 7-6'--R Page 3- of <br /> ---_ GeoEnviron rnental, Inc. <br /> y <br /> � •��•�� 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> Client ProjecManager Tests Required <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> r �\ C/ AGE <br /> Project Name �1 Client E]e <br /> 1 , e� / <br /> Sample Location Sample Type No. of <br /> Date Time Water Solid Notes <br /> Number Description CoGrab. Air Conts. <br /> mp. <br /> e inq�is y: ( rg at r ecerve y: ignature T-'q- Date/Tinge <br /> Relinquished by: (Signature) Received by: (Signature) Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date'Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Date/Time <br /> Method of Shipment: Laboratory <br /> oblelol�/�ICE/p ✓ VOAS 0&G M�1 Special Instructions: OCONOITION �� IN I hereby authorize t e performance of the above indicated work. <br /> HEA �Pnr.€Ag APPROPRIATE <br /> . � <br />