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i i i i i i � i• iiiiilit� � .... <br /> t ' Advanced a�� a [0bb <br /> CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental Inc. Dace Page of <br /> 837 Shaw Road- Stockton, California- 95215 - (209) 467-1006- Fax (209)467-1118 <br /> Pro act Manager <br /> Client L , Tests Required <br /> A Phone umber <br /> Samplers (Signature) Invoice <br /> �- AGE <br /> 'roiect Name ;'2— -� <br /> T' fLClient ❑ <br /> Sample Location Solid Na °f Notes <br /> Date Time Water Sample Type <br /> Number Description comp crab Air Cants "',,;N - �;, - s <br /> foa*r 4- LID <br /> r <br /> e rnquis e y ( ign re) RReceived y (Signature) Date/Time <br /> � ime <br /> Relinquished by (Signature) Received by (Signature) Dale f <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time I Received p or y hIr � D %kine <br /> Method of Shipment Laboratory Name <br /> W4-A t[J-1 C' C <br /> Special Instructions — e'.1—PRISP'1ATION I hereby authorize Oe performance of the above indicated work <br /> iY1f{I1 ER t• <br />