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ffffffff� � iiliiiiiliis �� � ififi� filiiiiiii■ : l� � il1• ilk � iiiiiii� 111111)♦� l� <br /> j Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvirorimental, Inc, Date '�i ° Page ---I— of—/ <br /> 837 Shaw Road-Stockton, California-95215- (209)467-1006 - Fax (209)467-1118 -0 <br /> Client Project Manager j / / <br /> � �� Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> Project Name AG� <br /> I L �-� 5 11C L _ L " Client ❑ <br /> Sample Location Sample Type <br /> Number Description Date Time Water Air Solid C st Notes <br /> Comp Grab <br /> `�� I I A <br /> 1' o <br /> Received by'(Signature)Reis e y ( ig ture) <br /> in �� Oatsl7rme <br /> n , <br /> Relinquished by (Signature Received by <br /> M- r <br /> 1 �� 5� Dhte rme7 S �r S <br /> Reirnquished by (Signature) Received by 11lobile Laboratory for field analysis (Signature) ate[Time <br /> Dispatched by (Signature) Date/Time Received for Laboratory by Date/Time <br /> Method of Shipment ti r LaboralName } <br /> 1 a t �-,J%0 <br /> Special instructions I hereby authorize the performance of the above indicated work <br /> WV <br />