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i � i ■i i i i i i � � i■� t�1 Ittttftttra� >wtrrrr: <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date ' � Page !'L Of 3 <br /> 837 Shaw Road - Stockton, California-95215 - (209) 467-1006 - Fax (209)457-1118 <br /> Client Protect Manager Tests Required�Le <br /> e9 <br /> P 3one Nmb r / <br /> 7- <br /> Samplers (Signature) Invoice <br /> Protect Name f r ` <br /> Client ❑ <br /> Sample Location Date Time Sample Type Solid No of ' `C/`� y Notes <br /> Number Description comp crab Air Conts <br /> iL <br /> Axy I ovi <br /> W2 k ���� t -3 X X X <br /> e inquis a ( ignature) eceive y (Signature) D telTime <br /> Relinquished by (Signature) Received by (Signature) CatelTr e <br /> Relinquished by (Signature) Received by Mobilu laboratory fa, held analysis ( ig azure) Dale/Time <br /> Dispatched by (Signature) Datefrime ecewad or abolatory/by I <br /> I� <br /> Method of Shipment Lob olrttoky Name <br /> Special Instructions 11 ` F_"/ I hereby authorize the performance of the above indicated work <br />