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� eeea� � w� tttttw t� ttti � tt� tt� � � i• � � � <br /> `-� Advanced CHAIN PF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date V fVI Page --�— of� <br /> 837 Shaw Road Stockton, California- 95215- (209)467-1006 Fax (209) 467-1118 <br /> Client r Pro ect Manager <br /> . I� Tests Required <br /> Phone Njimber <br /> Samplers (Signature) i Invoice <br /> Project Name AGE <br /> OZIL ( Client p <br /> Sample Location Sample Type <br /> Number Description Date Time Water Air Solid No of Conts Notes <br /> Comp Grab <br /> i <br /> e inquls e y atur Received by ignature <br /> Data ime <br /> P <br /> Relmquis ed by (Signature) Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) < ' DatelTime <br /> Dispatched by (Signature) DatelTime Recerveddar ab toryo. <br /> Dat (Time <br /> Method of Shipment Laboratory Name / <br /> Special Instructions ��, ) /� I hereby authorize the performance of the above indicated work <br />