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� i• � � till♦ ® � � � � � � � i• � - �-- i <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc.--_ . :. �� of <br /> Date 3� e <br /> Not-111071 Crtlifrrr7lirr <br /> 1803 West March Lane,Suite A-Slockton, California-95207-(209)956-0264-Fax(209)956-0700 2/7� &;v <br /> Client a 1 � S Project Manage, <br /> O Tests Required <br /> Phone Number / <br /> Samplers: (Signature) rte° /Invoice: <br /> Project Name t _ / / ,/ <br /> AGE <br /> Client ❑ <br /> Sample Location Sarr1ple Type <br /> Number Description Date Time Water Solid No. of <br /> Comp. Grab. Air ContS. f - <br /> 'f <br /> 3 alp [ <br /> t <br /> �S <br /> .64900 <br /> e tnquis a y: ( ,gnalure) a el y: ( rgnat ) <br /> f� � arelTbe --�utir.�, <br /> elinquis ed by: (Signature) ' y �\J <br /> eived by: (Signature) <br /> Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) <br /> Date/Time <br /> Dispatched by: (Signature) bate/Time Received for Laboratory by: Dale/Time <br /> eth_d of Shipment: 7 / , / Labofatory Name r r <br /> Special Instructions:/ I hereby authoriz the performance of the above indicated work. <br /> t <br /> i. OF t yt <br /> HFAD SPACEABSe4T_ AtUl xlQ ll,� <br />