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' CHAIN OF CUSTODY RECORD <br /> L Advanced <br /> 1, .3 Date d✓il%�, age of <br /> GeoEnvironmental� Inc. - <br /> 4005 North Wilson Way-Stockton,California-95205 (209)467-1006-Fax(269)467.1118 <br /> Project Manager <br /> Client y' l's �--- '�" 1 I Tests�Reqquo-ed <br /> -Phone-Numtier -- <br /> Samplers!"(Signature) F �'` �' Invoice: <br /> AGE <br /> Project Name Client ❑ <br /> Sample Location I, Sample Type <br /> No, of „h`" / - Notes <br /> i. Date Time Water Solid �.� r <br /> Number Description comp. Grab. Air Conts. <br /> \ l <br /> 1; <br /> Reli�,wistied by.: (Signature) Received by: ( ignature) Date/Time <br /> Date/Time <br /> Relin— quish`6d by: (Signature) Received by: (Signature) ., <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> d, <br /> Dispatched by: (Signature) a Date/Time Received for Laboratory by: Date/Time <br /> d <br /> Method of Shipment: Lab story Name i <br /> Special Instructions: Y F j I hereb authorize the performance of the abov a in <br /> work. <br /> !I `1 r'.1 `I4 u <br />