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r � � � r, �■■ r � r r�r � r r � r r � r ri � <br /> [ Advanced _ CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date ` �7_ Page of <br /> 837 Shaw Road-Stockton, California 95215- {209)467 1006 - Fax (209)467-1110 <br /> Client Pro ct Manager <br /> Tests Required <br /> � Sy( -1 <br /> 3 trL� Phone Number <br /> Samplers (Signature) ' Invoice <br /> Protect Name �� �i�� �� - AGE ' . <br /> Client ❑ <br /> Sample Location Sample Type No of <br /> Date Time Water Solid Notes <br /> Number Description Comp crab Air Cants <br /> r� V <br /> elmq e y ( igne) Received y ignature t 0 telTeme <br /> � <br /> Relinquished by (Signature) Received by (Signature) Dat4TIM6 <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Sign e) Date/Time <br /> Dispatched by (Signature) DatelTime Recewod forAaVbratory by D e/Time - <br /> Method of Shipment (kp600ratory Name <br /> 17r- <br /> Special instructions { i hereby authorize the performance of the above indicated work <br /> r — <br />