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� i♦ i♦ I♦ (♦ � i♦ � � i♦ i♦ � � i♦ i♦ � 1l♦ i♦ � <br /> Advanced <br /> CHAIN OF CUSTODY ECORD <br /> ( - <br /> -:== =- GeoEnvi:ronmental, Inc. .�j j(� � Date PayeOf 4q( <br /> - 837 Shaw Road- Stockton California- 95215 - <br /> 2 (208) 457-1006- Fax (209) 467-1118 <br /> Clie t Pr f' t Ma ger Tests Required <br /> _ntP ne Nu ber <br /> Sa (Signature) Invoice: <br /> Project Name <br /> AGE <br /> Client ❑ <br /> i <br /> Sample Location Sample Type No. of <br /> Number Description Date Time _ Water Solid Notes <br /> comp. (arab. Air Cbf1tS. <br /> t <br /> - yEU 'z - <br /> ICFJ <br /> GOOD CONDITION plt0?MATE <br /> AD SPACE ABSENT_.. -- IITAINE-RS <br /> DECH 01UNATED! -""""' <br /> WAS Odea <br /> I n q is y: (sign 4 naceNed by: (Signature) ate/Time <br /> Z03j3 <br /> Relinquished by: (Signature) Received by: (Signature) DaterTime <br /> Relingr ished y: (Signature) Received by Mobile Laboratory for field analysis: (Signature) t)ale/1lms <br /> tliapatched by: (Signature) Daterrime fie r La tory �•� D&Wflme <br /> A/5 { <br /> fdethoe of Shipment: " Labo or Nam <br /> Special Instructions: I hereby a c e the p rmance of thJ above indicated work. <br /> REC'D S ALED& INTACT VIA (-# O'Ve r'n I-CAI <br />