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I• � � � � � � l• � � 1• � � � � ■� >_ titititfA ttttttt� <br /> • s s <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date !kho Page of <br /> 837 Shaw Road - Stockton, California- 95215- (249)467 1006- Fax (209) 467-1118 f1 r 0411 411 <br /> Client C � � j Project Manager � Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> Project Name D AGE <br /> Client ❑ <br /> Sample Type � <br /> Sample Location Date Time Water Solid No of Notes <br /> Number Description Comp Grab Air Conts <br /> i <br /> Relinquished i atureReceived y (Signature) r. D terrime <br /> 117 <br /> Relinquished by (Signature) Received by (Signature) Date/Tr e <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatelTurme <br /> Dispatched by (Signature) Date/Time Receivod for Laboratory by Date(Tim9 e <br /> YFL" � � <br /> Method of ShipmentLaboratory Na <br /> � <br /> Spacrat 1 hereby authorize the performance of the above Indicated work <br />