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1♦ lobl= = v = = E• ttttttttt� <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date _ Page of- -- ' <br /> of Northern California <br /> 1803 West March Lane Susie A Stockton California-95247 (209)956-02154-Fax(209)956-0700 <br /> Client C �� Project Manager T M �u��' � Tests Required <br /> Phone Number <br /> 9-J C <br /> Samplers (Signature) Invoice <br /> AGE ,K <br /> Project Name s G Client ❑ <br /> Sample Type <br /> Sample Location Date Time Water Solid No of Q� Notes <br /> Number Description Camp crab Air Conts <br /> W (tA V� 1 I <br /> Q if / its J <br /> 3 lr2 <br /> __ 4rIL,f5 K X <br /> etrn uis a by ( sgriature eceive y (Signature) Date/Time <br /> —,i fl-qo <br /> y� Date/Time <br /> Relinquished by (Signature) Received by (Signature) r <br /> Relinquished by (Signatu(e) Received by Mobile Laboratory for field analysis (Signature) RatelTime <br /> Dispatched by (Signature) Date/Time Receiv for Laboratory by Date/Time <br /> -� d <br /> Method of Shipment /� r Lab ratory Mame r <br /> C CJ <br /> Special Instructions i hereby authorize the performance of the above in icated work <br />