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� � tii111riri � ■� � � � f� � � � � � � � � <br /> Advanced CHAIN OF CUSTODY RECORD <br /> Date 17 a Page of . <br /> GeoEnvxronmental, Inc. <br /> 837 Shaw Road- Stockton, California-95215 -(209)467-1006- Fax (209)467-1119 <br /> Project M a <br /> Client of � g r Tests Required <br /> P e Number <br /> 7 /X,(D <br /> Sam rs (Si Lure) Invoice <br />� <br /> Project Name 1,� rpt1-1 � CG <br /> I <br /> Ie E3 <br /> Sample Location Sample Type <br /> Date Time Water Solid No of Notes <br /> Number Description comp Grab Air Conts <br /> X401 01-LLO I t//Z/,Vs / a// <br /> �. <br /> ? —/ TP t I <br /> 7 ;fit 6l-1 �o3 1t 4.1 <br /> Relinqu� igna ure ecetve y ignature telrime <br /> Q 0 <br /> Relmqutshed by (Signature) Received by (Signature) o [3atelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DaterTime <br /> r <br /> Dispatched by (Signature) Date/Time iReceivedlor Laboro by RITIMe <br /> Method o1 Shipment LaboyAry a e <br /> qi <br /> Special lnstructtonS` - s t hereby a fixe th rf rmance of the above indicated,work <br /> Ju%zo"6- , <br /> C <br />