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{ <br /> �L Advanced CHAIN OF CUSTODY RECORD <br /> -- GeoEnvironmental, Inc. Date Page Of <br /> ' 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> IOf Of 1I <br /> Client prole nage Toms Required <br /> Phone Number <br /> Sa lers: ign ure) Invoice: <br /> �} AGE.� <br /> Project Name If �.� Client ❑ <br /> Sample Location Sample Type No. of <br /> Date Time Water Solid Notes <br /> Number Description Comp. Grab. Air Conme <br /> ts. <br /> A d47lo-Z) <br /> fl LJ 2- <br /> 50 <br /> ehn u s e y' (Signatu TNv.d <br /> : ignatu /ate 1A J <br /> Relinquis ed by: (Signature) R : (Signature) <br /> Da e/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> G <br /> Dispatched by: (Signature) Dale/Time Received for Laboratory by: Date/Time <br /> Method of Shipment: Labora ry Name <br /> i <br /> Special Instructions: I hereby,&utho ze Ih p dorm ce of the above indicated work. <br />