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�s— w�inw ti t� I• I• 11=11 I• <br /> • <br /> Advanced • CHAIN F CUSTODAECORD <br /> ( <br /> GeoEnvironmental, Inc. r r Datelfr� Page ---� of <br /> lb <br /> 837 Shaw Road Stockton, California 95215 - (209) 467 1006 Fax (209)467-1118 <br /> Client Project Marner <br /> / Tests Required <br /> PPone N' rnber/ <br /> jp Q-i`7 I <br /> Sam pl (Sign re) Invoice <br /> -1 Client EJ <br /> Project Name AGE k:e ,I_ ❑ <br /> Sample Location Sample Type No <br /> i <br /> Number Description <br /> Date Time Water Air Solid Contsf ` Notes <br /> Comp Grab <br /> v <br /> V(?4fi 0 r <br /> z a ,.x4 `o-xil <br /> HeVinqis e ygnal re ece ve y gna ure 0 elTime <br /> Reished oy (5rgnature} VReceived by (Signature) Dateffi e <br /> Relinquished by (Slgnatufa) Recelved by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Received for aboratory y r <br /> Date/Time <br /> Method of Shipment r Le otalo y ame <br /> Special Instructlona I hereby home the 96ilarmance of the above Indicaled work <br />