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SEEMED ■� �� <br /> Advanced C-) CHAIN PF CUSTODY RECORD <br /> GeoEnvironmental Inc. <br /> Date / r r g Page of <br /> 837 Shaw Road - Stockton, California-95215-(209)467-1006- Fax(208)4137-1118 <br /> C4ent ' fc:2- Project Manager . <br /> JFIL Tests Required <br /> Phone Number <br /> LA70-11 <br /> Samplers (Signature) Invoice <br /> Project Name AGE <br /> " "---Wa—ter <br /> Client <br /> Sample Location Sample TypeNo f <br /> Number Description Date Air solid Costs Notes <br /> Comp Qrab <br /> X <br /> r <br /> elinrs e ry ignature ace ve y gnature <br /> A Data(Time <br /> Relinquished y (sign we) Received by (Signature) �J <br /> DateMme <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) <br /> DatelTime <br /> Dispatched by (Signature) Date/Time a iv Jpr Laborar <br /> Daiegime,t <br /> Method of Shipment �" � � ' •""'-" " "� � �" Gr ��U <br /> Lab* _tory N me <br /> (4001 11 instructions <br /> / !7 �j _ I he <br /> reb autharizovine performance of the above indicated work <br />