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f� fly f� �� f� fififififif� � � 1(• A Ifififffff■ � f� � <br /> Advanced CHAINF CUSTODY RrECORD <br /> -__ GeoEnyironmental, Inc. Date �' �'� Page T of� <br /> 837 Shaw Road - Slockton, California- 95215 - (209)467-1006- Fax (209)467-1118 <br /> Client Project anage <br /> Tests Required <br /> 7 P ne N mber <br /> 001)1�61'� <br /> arr rsfgnature) Invoice <br /> Project Name .( AGE ®/ <br /> Client ❑ <br /> Sample Locationtion Date Time Sample Type No of <br /> Number Description Water Air Solid Conts Notes <br /> Comp Grab <br /> r� rrt� <br /> V <br /> r•�� <br /> IT <br /> i <br /> e inis a ignatu Receivedy Ignatureyrxl; D tel7rme <br /> 1 <br /> Rehi5quished by (Signature) Received by {Signature} <br /> Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Dateffime <br /> Dispatched by (Signature) Daterrime Recelvad lot Laboratory by Datefrime <br /> f:\ Z4 J V <br /> Method of Shipment Laboratory 'Imo <br /> Special Instructions 1 hereby aut :za the performance of the above Indicated work <br />