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Mill IF 070-/IpTir <br /> ( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date Page ___L of� <br /> 837 Shaw Road - Stockton, California-95215-(209)467-1006 - Fax (209)467-1118 <br /> Client Pro ect Manager <br /> # I Tests Required <br /> F110ne umber <br /> Sers (Sgnatu ) Invoice <br /> Project Name f f AGE.e <br /> ( l Client ❑ <br /> Sample Location Sample Type <br /> Date Time Water Solid No of Notes <br /> Number Description Comp arab Air Conts <br /> CA <br /> z t <br /> t <br /> e inqui y fig at Receivedy ignature to rme <br /> mpRelinquished by (Signature Received b (Signature) z © / o <br /> y I g ) Daterrime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Datef ime <br /> i <br /> Dispatched by (signature) DatalTime 7c,, <br /> ceived for Laboratory by Datef ime <br /> �� `r <br /> Method of Shipment / w Labor ka a- <br /> a <br /> Special Instructions 1 hereby a thoriza t performance of the above Indicated work <br />