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-m- d— CA <br /> ( _ Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. <br /> Date Page of <br /> 837 Shaw Road- Stockton, California-95215 -(209) 467-1006- Fax (209) 467-1118 <br /> CSS <br /> - fly � <br /> Client �� �l` -%!� Project Manager <br /> ',( 6i" � Tests Required <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> Project Name :� t AGE <br /> Client ❑ <br /> Sample location Sample Type ti _ <br /> -m�..---_z.�-DateF._-T=Tme ___�: _ �— FNo.-o(� - / - <br /> _ _... . <br /> __. .�Nurfiber__. . _.. Description Water Solid - �� _ -_Notes : <br /> Comp. Grab. Air Conts. <br /> & *3 j�4 <br /> 14 <br /> e me a y: ignatu e) eceive y: rgnature PAq tU4l 7—A-7— <br /> DatetTime <br /> Relinquished by. (Signature) Received by: (Signature) <br /> Data/Time <br /> Relinquished by; (Signature) Received by Mobile Laboratory for field analysis:(Signature) DatalTime <br /> Dispatched by: (Signature) Datemme Received for Laboratory by: Date/Time <br /> Method of Shipment: -3 <br /> / r Nam _3 s t!3 <br /> Special Instructions: I hereby authorize the performance of the above Indicated work. <br />