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� Advanced <br /> CHAIN OF CUSTODY WORD <br /> GeoEnvironmental, Inc. Date Page of <br /> 4005 North Wilson Way Stockton Califomia-95205-(209)467-1006 Fax(209)467 1118 <br /> 1 <br /> Protect Manage 1 <br /> Client G Tests Required <br /> Phone Number <br /> ZCA A6 Pt <br /> Sa er (Sl tune) Invoice <br /> AGE <br /> Project Name ` Client ❑ <br /> Sample Type Q <br /> Sample Location # <br /> Number Description Date Time Water Ail Solid Conts No of Notes <br /> Comp Grab <br /> - /l 2 k <br /> J-1 <br /> l <br /> rr r( 03 <br /> f. it r <br /> E <br /> P <br /> S- <br /> -Relinq rs e y i I ure Received by (Signature) DatelTrme <br /> / 6l <br /> AJD�A 0 ILL Z-1� <br /> Rehn urs ed by (Signature) Received by (Signature) Daterri e I <br /> r <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatefTeme <br /> L <br /> Dispatched by (Signature) Date/Time ratory by , Date/Time r <br /> 1//—,)3— 1 <br /> Method of Shipment Laboratory Name <br /> r <br /> C E 4MI:71 1cc- <br /> Special instructions <br /> r f hereby authorize the performance of•t a above indicated work <br /> ti <br />