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i i i i I♦ � �■ l♦ �� i .... ..r. � a_ ...� <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnyironmental, Inc. <br /> Date Page of ' <br /> 837 Shaw Road -Stockton, California-95215 -(209) 457-1006 - Fax (209)467-1118 <br /> Client 1`t L G� P1611het Ma g <br /> Tests Required <br /> P ne umber ' <br /> Sampi rs (Signature) `� Invoice <br /> Prosect NameAG E <br /> Client ❑ <br /> Sample Location Sample Type No of <br /> Number Description Date Time Water Air Solid Cants Notes <br /> Comp arab <br /> LO I -94,,V. I I <br /> e i e gna e) ec Q q Zpe APIi7f}PM ateffime <br /> U01 179� <br /> Relinquished by (Signature) Recelved by (Signature) alelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature} OalelTime <br /> Dispatched by (Signature) DatelTime I Receive or Laboratory b telTlme <br /> Method of Shipment Lebo a <br /> r V 11 <br /> Ccs Le.� tJ . i (h r(oSpoore hereby a h nzIndicated work <br /> i <br />