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i i • - ' <br /> ( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnv><ronmental, Inc. <br /> Date Page <br /> —Z— 09-- <br /> 837 Shaw Road- Stockton California- 95215 - (209)467-1006- Fax (209)467-1118 _ r <br /> Client Pro ect Mana or �p <br /> Tests Required <br /> Phone Number <br /> ft 4" ` <br /> Samplers (Signature) Invoice <br /> Project Name �' AGE t< <br /> Client ❑ <br /> Sample Location Sample Type No of <br /> Number Description Date Time Water Air Solid Conts Notes <br /> 111 Q Comp Grab <br /> -1 6 <br /> G� pCa G I <br /> ii <br /> 964 q 15 <br /> I - 216 ,�;o <br /> C � -; � <br /> e in ui e y ignat Receivedy ignature DqtefTime <br /> Relinquished by (Signature) Received by (Signature) Date/Time <br /> Rehnqurshed by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatelTime <br /> Dispatched by (Signature) DatefTime Received for Laboratory by DatelTime <br /> �r_ G � <br /> Method of Shipment Labpratory Name ` <br /> Special Instructions I hereby authorize the performance of the above indicated work <br /> 1 <br />