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' 1� � S � � � � (• � � � � Itl■II ■w �t�■ �■ <br /> ' Advanced <br /> � ' CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc Date P Page 1 _ <br /> golk837 Shaw Read - Stockton, California- 85215 - (209)467 1406- Fax (209) 467-1118 1 <br /> Client Project Manager <br /> Tests Required <br /> Phone umber <br /> Sampler (Signature) invoice <br /> Project Name AGE 0\ <br /> r ' _ Client ❑ <br /> Sample Location Sample Type No of <br /> Number Description Date Time Water Air Solid Conts Notes <br /> Comp Grab <br /> WIA <br /> llq� <br /> 144141-5 16;0 <br /> 10x -� <br /> �a m�q'is e y igna�ture ece�e y rgn�tsue ate17 me <br /> l ' ! r <br /> Retinquishe by (Signature) Received by (Signature) Qat (Time <br /> Relinquished by (Signature) 75Mi{il?AUBPACBIa s tdT,,,.,,,,,.,. bt1 �aboratpry for field analysis (Signature) t7ate(Time <br /> DSCEitARR+rA7J3�IN I3AV W It+F�AB.� <br /> Oiapatetled by (Signature) me se ed for Laboratory by Date/7lme <br /> � '�Lt�t r9'I <br /> Method of Shipment aboratory Name <br /> Special instructions I hereby auth ri a performance of the above Indicated work 1 <br />