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M M M v M l• <br /> ( *Advanced • CHAIN OF <br /> CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date (X,,)lVt Page 2 of 3 <br /> 4005 North Wilson Way Stockton,California-95205-(209)467-1006-Fax(209)467 1118 <br /> Client CAL E fs Project Manager <br /> Th,, Cue e'r Tests Required <br /> Phone Number <br /> hof-4L7- toad <br /> Samplers (Signature) Invoice <br /> Project Name ���- <br /> CAL ve is � t AGE [2r <br /> Client ❑ <br /> Sample Location Sample Type -� <br /> Number Description Date Time Water Solid No of �� �� <br /> Comp Grab <br /> Alt Conts Notes <br /> �l� l4L�c�U ty � <br /> ��� 1br ►�z� X )< <br /> Re MEquis e y (Signature) ecerve <br /> ignature <br /> MEE <br /> Relinquished by (Signature) Received by (Signature) <br /> DatelTime <br /> Relinquished by (Signature} Received by Mobile Laboratory for field analysis (Signature) <br /> Date/Time i <br /> Dispatched by (Signature) Date(t rme Recap d to aborato by <br /> DatelTi e � <br /> Method of Shipment <br /> Laboratory Name <br /> 3pectal Instructions <br /> I hereby authorize the performance of the above indicated work I <br />