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I <br /> CHAIN OF CUSTODY RECORD.' <br /> Advanced Date Page of <br /> GeoEnvironmental, Inc. <br /> 837 Shaw Road-Stockton, Calitofnia-95215 -(209)467.1006- Fax (209)467-1118 C J <br /> Project Manager Tests Required <br /> Client <br /> Phone Number <br /> S plers: (Sign Invoice: <br /> Tests Required <br /> Inva <br /> AG`'< <br /> Clier <br /> Project Name aient ❑ <br /> Sample Location Sample Type <br /> Date Time Water Solid No. 0 -Z�7 Notes <br /> Number Description Air Conts. <br /> Comp. Grafi. <br /> (Y--, 1 X, <br /> ee <br /> 117 <br /> --7 7 <br /> z9- 0z <br /> /Reiinquished r)y: (5ign)rwre)---- A—e.'ce-N-ed by: (Signature) Date[Time N. <br /> Rdrinquished by; (Signa Received by: (Signature) DatefTime <br /> Relinquished by: (Signature} Received by Mobile Laboratory lot field analysis:(Signature) Date/Time <br /> Dispatched by: (Signature) DatefTime Received lot Laborat by: Date/Time <br /> :7 <br /> I <br /> Method of Shipment ora"-C� 0me <br /> Special Instructions: I hereby authofile the performance of bov'm�indicated work. <br /> 7" <br />