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CHAIN OF CUSTODY RECORD <br /> ( Advanced Date 6D/1(010-1 laage Lt �� <br /> GeoEnvironmental, Inc. <br /> 837 Shaw Road-Stockton, California 95215- (209) 467-1006 - Fax(209)467-1118 <br /> Client PrV ,C -� Vz,� Protect Manager <br /> G �... Tests Required <br /> `tom co e'GlO_v <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> �f1 AGE <br /> Protect Name ` Client ❑ <br /> Aj <br /> sample Location Sample Type o of <br /> Number Description Date Time comWat erreb Air Soli Conts Nates <br /> VMvO �O Gz (W L1 e Lt <br /> i <br /> e s e y ig ture) RReceived y (Signature) Date(Time <br /> p�etL10� �U <br /> Relinquished by (Signature) Received by (Signature) DatalTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Dele/Time <br /> e 1 c <br /> Dispatched by (signature) Date/Time R gWI-abstory /���/Tim�� <br /> Method or Shipment ` �, _�� yl—t__ <br /> _ k J Laboratory Name b'o—kk <br /> Special Instructions l� ,� L I hereb authorize the perform a of the abo ated work <br /> I <br />