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1• moi• � r I• � � � � � � � � � � � i• � i <br /> Advanced �� CHAINOMU[ CUSTODY CORD <br /> r -- <br /> GeoEnwironmental, Inc Date Page Of <br /> 837 Shaw Road- Stockton, California- 95215- (209)467 1006 Fax (209)467-1116 <br /> Client Projeg Magagey Tests Required <br /> P e umber <br /> )1167 0 t-112 � � <br /> Sa <br /> I(& ature) �ry Irnolce <br /> R X AGE <br /> Project Name c <br /> Client ❑ <br /> Sample Type Sample Location Date Time Water 5olfd No of � Notes <br /> Number DescriptionDate <br /> Grab Air Conts <br /> el is a y { gn ref Received y (Signature) <br /> ateffi e <br /> Relinquished b (Signatur ) Received by (Signature) Difteffirne <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatelTime <br /> Dispatched by (Signature) Daterrime Received f bo tory by atelTime <br /> Method of Shipment <br /> La oral am <br /> C J <br /> Special Instructions I hereby auth ze the rformance of the ab a Indicated work <br />