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i � ti � � � � � � � � � � � !• � � fid � � <br /> I <br /> CHAIN F CUSTODOECORD <br /> Advanced Date S FWag. af� <br /> GeoEnvironmental, Inc 7 <br /> 837 Shaw Road - Stockton, California-95215 - (209) 467-1006- Fax (209) 467-1118 <br /> Client P �ect Manager Tests Required <br /> V1-VL4- <br /> P one Number <br /> Samplers (Signature) Invoice <br /> AGE <br /> Project Name Client ❑ <br /> Sample Type <br /> Sample Location Solid No of Notes <br /> Date Time Water <br /> Number Description Comp Grab Air Conts N <br /> N 4 <br /> I A <br /> e�nquis a ig ture Received by ignalure D LelTrme <br /> a 6 <br /> Relmq fished by (Sig ature) Received by (Signature) DatefTirie <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) yJ��{'� DatelTrme <br /> t 4• \ ry P <br /> Despatched by (Signature) DatelTrrne Received for Leborato y DatelTim <br /> .� <br /> 90 <br /> Method of Shipment L rayory Name <br /> Cc, � <br /> (--- <br /> Special Instructions 'A' ) <br /> r f I hereby authorize the performance of the above indicated work <br /> ' )E / <br />