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!' l♦ � � � � i� i♦ f� l♦ � � � � (♦ l♦ � ice■ � <br /> Advanced CHAINOf CUSTODY ECORD <br /> - GeoEnvironmental, Inc. - Date 67 Page of� <br /> 4005 North Wilson Way-Stockton,Califomia-95205-(209)467-1006-Fax(209)467-1118 <br /> ClientProject Manager <br /> �L1` tTests Required <br /> Phone Number <br /> Samplers: (Signature) 1 Invoice: <br /> Project Name AG <br /> Ciien ❑ <br /> Sample Location Sample Type No. of <br /> Number Descri tion Date Time Water Solid Notes <br /> p comp. crab. Air Conts. <br /> � a <br /> ,�j en ,� ; 7056,0 <br /> t 7056.1 <br /> r <br /> AFFKL M. <br /> I} II <br /> Re] a ( nlure) Received y: -nature tTime. IO-A <br /> R (Signature) <br /> � <br /> ived,b : (SIMU �,Z A t ��� DalOtTime <br /> Reiinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) TA:c Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: pate/Time <br /> Method of Shipment: LaboratoryName j <br /> C G l <br /> Special Instructions: I hereby authorize the performance of the above Indicated work. <br />