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i <br /> s { Advanced �-� CHAIN OF CUSTODY RECORD <br /> Date �" Page „� of..,-� <br /> GeoEnvironmental, Inc. <br /> 837 Shaw Road- Stockton, California-95215- (209)467-1006 - Fax (209)467-1118 <br /> Client Project LLManager �l'1 A � Tests Required <br /> Phone mber <br /> &E�� R1 <br /> Samplers (Signature) 1 Invoice <br /> AGE <br /> Project Name -1-A 17a J Client L <br /> Sample Type + <br /> Sample ocatfon Date Time Water Solid No of /4 Notes <br /> Number DescriptionComp Grab Air Conts <br /> i <br /> e inquis y ( rgnature eceive y rgnature J �1. } �� Date(Time <br /> 7/47 <br /> Relinquished (Signature Received b Daie ime <br /> Relinquished by (Signature) ReceivedWI a atory for field analysis (Signature) DatetTime <br /> Dtspatched by (Signature) DaterTime Received for Laboratory by Date rime <br /> Method of Shipment Laboratory Name n / r <br /> Special Instructions I hereby authorize the performance of the above dicated work <br />