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( Advanced CHAIN OF CUSTODY RECOR <br /> -/� <br /> - - GeoEnvironmental, Inc. Date Page of <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 �r,��,1"1 x n ,F, <br /> Client p 2 Project'Manager Tests Required <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> AGE <br /> Project Name / � Client ❑ <br /> Sample Location Sample TypeDate Time Water Solid No. of Notes <br /> Number Description Comp. Grab. Air Conts. 96247 <br /> 96248 <br /> e mq a y: ( rgn ecerve y: (Signature) n DatefTime <br /> Relinquished by: (Signature) Received by: (Signature) 1`\!J Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time R ce ed for Laboralor by: Date/Time <br /> Method of Shipment: Laboralor Nam'ee <br /> Special Instructions: VRS RG ETALS OTHER I INreby`aut Drize She performance of the above indicated work. <br /> nl-r+rnt{T ! <br />