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CHAIN OF CUSTODY RECORD <br /> [ Advanced <br /> Date ��-13-Cy V Page --A— of--�—� <br /> GeoEnvironmental, Inc. <br /> 837 Shaw Road -Stockton, California- 95215- (209) 467-1006 - Fax (209) 467-1118 <br /> ClientL Project Manager Tests Required <br /> � ��- KTt3il �Ls-Ifits S�rl G 111'1' <br /> Phone Number <br /> - <br /> 4-1 U ' I <br /> Sample s: (Signature) Invoice: <br /> AGE P� <br /> Project Name Client ❑ <br /> Sam <br /> Sample Location pate Time Water l ype Solid No. of / Notes <br /> Number Description Camp. Grab. Air Conts. <br /> >s�3 t►-t3 o s �,v 11-� l X 1 y s In ?, <br /> 5/ �fGrh bJt6:��` <br /> e,tC C ci 1r'til <br /> e ' i nature} ecerve y: ignature {]atelTime <br /> q he y: (Signature) Received by: (Signature) tlatelTime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Labo`ator.y by: DatelTime <br /> // r p <br /> Method of Shipment: Laboratory Name =-,,-+_''L <br /> Ci <br /> I hereby authorize the performance of the above indicated work. <br /> Special instructions: <br />