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0 ( -- C) z7 <br /> Advanced CHAIN OF CUSTODY RECORD <br /> - GeoEnvironmental, Inc. Date Page <br /> 837 Shaw Road Stockton, California- 95215 - (209)467-1005- Fax (209)467 1118 <br /> ClientProject Manager <br /> . � Tests Required <br /> � <br /> Phone Number <br /> Sam s (Signature} �� "�' Invoice <br /> Project Name A J, , V AGn �] <br /> � W IOWA � Client ❑ <br /> � I . <br /> Sample Lo atSample Type Solid <br /> ion No of <br /> Number Description Date Time Water Air Conts Notes <br /> Comp Grab <br /> W-017-0-3 L2.3 L-3—V�( �)id <br /> got <br /> e inqis y igna re eeerye y ignature atelT <br /> llelln Zoo <br /> Relinquished by gnature Received by (Signature) DatelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Dat*Mme <br /> Dispatched by (Signature) DatetTime Received for Laboratory by Date/Time <br /> Method of Shipment a Laboratory <br /> Special Instructions I hereby auquakize the performance of the above indicated work <br /> (�J 041� 1 <br /> I♦ M IN <br />