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1-7 r77 C'7 r7 r—" r_7 r",. r...T t-1.1 r_7 C "T r� r-11" r" r_7 17_11 r-7 C ". <br /> ( Z _ Advanced CHAIN OF CUSTODY RECORD <br /> " GeoEnvironmental Inc. Date 3> Page -I— of <br /> 837 Shaw Road- Stockton, California- 95215-(209)487-1008 - Fax (209) 487-1118 ) <br /> Client Project Manager <br /> fa'1 LL Ljr7 ce, <br /> Tests Required <br /> Phone Number <br /> ABzv. <br /> Samplers: (Signature) Invoice: <br /> Project Name 41181 C /i Za. 1 ✓ i �j ' ; AGE [ <br /> l� Client <br /> Sample location SamieTpe v <br /> _-- __.- � [)ate,.:_�--.Time--- ----- <br /> Saild <br /> Description�. ._� ,.,-� --- �Water.�.—. :Air = -...-No.or>ts, Notes <br /> comp. Grab. <br /> e inquis a y; ( ignature <br /> ) ecerve y: ignature <br /> —Relinquished y: (Signature) Received by; (Signature) Ty <br /> — Oalafrime <br /> Date/Time <br /> Retinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) <br /> Date/Time <br /> Dispatched by: (Signature) Date/TIme Received for Laboratory by: <br /> Date/Time <br /> Method of Shipment; Laborat Name o ' D <br /> Special instructions: 1 hereby authorize the performance of the above indicated work. <br />