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� Advanced <br /> CHAIN 9F CUSTODY RECORD <br /> - --- %'� GeoEnvironmental, Inc. 7 � �� d C''Cl Date Page l of <br /> 837 Shaw Road-Stockton, California- 95215- (209)467-1006-Fax' 09)467-1118 <br /> Client � Prolt;ct ager Tests Required <br /> P ne Number <br /> S p rs ( nat e) Invoice: <br /> AGE <br /> Protect Name (a � Chant <br /> / <br /> Sample Location Solid No of Notes <br /> Number Description Date Time Sample Type Water Air Cants , <br /> Comp Grab <br /> �� ® �- i <br /> 74507 <br /> f <br /> 74508 <br /> f <br /> t <br /> e inquis e y (Signatureeceive y gnature atsme! <br /> RelinqumFed by (Signature) Received by (Signature) Dafa/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) �01 Date/time Received for Laborato y Oa lTime <br /> t� Ci <br /> Method of Shipment Laboratory alae <br /> (2 <br /> Special instructions 1 hereb thorize 1&0 perfArmance of the above indicated work <br /> 1,0A J Cit- <br /> r L� <br />