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0 Advanced CHAIN OF C USTOD ECORD <br /> � ` <br /> _- -_ GeoEnvironmental, Inc. Date d� Page of <br /> 837 Shaw Road - Stockton, California 95215-(208) 467-1006 - Fax (209)467-1118 <br /> Client ►i"lG-Sc>ri X �, v��• if vtC�1"� Protect Managf � Tests Required <br /> Phone ut <br /> er <br /> V- ti <br /> Samplers (Signature) Invoice <br /> Project Name s a Y- �� Client ❑ <br /> Sample Location Sample Type <br /> No of <br /> k x <br /> Date Time Water Solid /� '�1 /`/�V Notes <br /> Number Description comp Grab Air Conts <br /> 12A t <br /> R4-)`0 ' I S',-Z �� <br /> a -Z1n f y 3b 1+ Ln <br /> 64 -301 /0/ia/[,3 �� X <br /> � 1-5-3 <br /> 9 35 r gjsl j''j 101,) <br /> e ingws e y (Sig at ireReceived y (Signature) Da /Ti,bD�in=� InI14TU-Sme <br /> (&;-; <br /> 'Relinquished b (Signature) Received by (Signature) ---y� date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) r Date/time <br /> Despatched by (Signature) Date/Time Recei d for Le oratory by Qatefrime <br /> Method of Shipment .� Laboratory ame <br /> �.- <br /> Special instructions I hereby authorize the performance of the above indicated work <br /> I <br />