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,` 1♦ i♦ ifill ittttit�l4rfteeeew <br /> Advanced CHAIN OF CUSTODY RECORD <br /> Date IVIA Page --1L of <br /> GeoEnvironmental, Inc. I <br /> 637 Straw Road- Stockton,California- 95215-(209)467-1006- Fax(209)467-1118 <br /> client PrgfdV Manager Tests Required <br /> X:�,"-z &�� <br /> P.4pne Number <br /> � 4 <br /> S rs (Signature) Invoice <br /> AGE <br /> Project Name p �, Client ❑ <br /> Sample Type <br /> Sample Location Date Time Water Solid No of Notes <br /> Number Description Camp (arab Air Conts <br /> i <br /> 1f1?1J6J 4)<I 11 68792 <br /> 68793 �— <br /> 3 1 <br /> 68794 <br /> e i e (Sig aturelRecelvedy (Signature) ate/Time <br /> Voss ,� <br /> -- LS a�ER 460 <br /> Relinquished y (Sig-naturw Receivltw(sig • e) PRESERVATION Date/Time <br /> Relinquished by (Signature) Receiv ry for't6R?A1WRJSIgtturaP Date/Time <br /> Dispatched by (Signature) DateJTime Received for Laboralory b Date(rlme <br /> V A <br /> I <br /> Method of Shipment 1 aboratnry a <br /> f Special Instructions I hereby au the perfa ansa of the above indicated work <br />