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! • <br /> Advanced ��l( CHAIN OF <br /> CUSTODY RECORD <br /> Date Page Z of <br /> GeoEnvironmental, Inc. <br /> 837 Shaw Road-Stockton, California- 95215- (209) 467-1006- Fax (209) 467-1118 <br /> Client 'k ' L 00 Project anger ' Tests Required <br /> 6-1_ Phone Nu r <br /> Samplers (Signature) Invoice <br /> Protect Name J 9� AGS ❑ <br /> Client _ <br /> Sample Type r <br /> Sample Location No of <br /> Number Description Date Time Water Air Solid Cants Notes <br /> Camp Grab <br /> vodA <br /> �7 S� <br /> Rel s y i nature) eoerve y r DatelTime �, <br /> tu 0 --� o kc, �QVvY gtg-"J 7—rj�5-- <br /> Rehnq is ed by (Sibn-a-Wrer Received y ( n re) <br /> �DatelTime <br /> 10 <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Dateffime <br /> Dispatched by (Signature) Datefrime recel o orator by 1, DateTTime <br /> Method of Shipment '. Leborat ry Name 4" <br /> Special lnstr coons I hereby authorize the performance of the above indicated work <br />