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1• � � � � � E• i• � � � � � � f)♦ 1• � : tt� <br /> Advanced CHAIN OF CUSTODY RECORD <br /> Geoftvironmental, Inc. Date e, Page --Z- of <br /> 4005 Mort Wilson Way-Stockton,California 95205-(209)467-1006-Fax(209)467-1118 <br /> 1 dM <br /> Client Prpjct Mana r <br /> Tests Required <br /> PP-ane N mberl <br /> (� 00 <br /> i <br /> Sa p Sig ture) Invoice <br /> Project Name AGF <br /> U,44,, gtt r-LI,4� Client ❑ <br /> Sample Lo f tion Sample Type <br /> No <br /> Date Time Water Solid ' ° <br /> Number Description Nates <br /> Comp Grab Air Conts , <br /> 49837 <br /> r <br /> ^r - ni - <br /> � <br /> Vini.5 a gnat a eceive y ignature lTime <br /> �Re <br /> ( Ignature) Received by (Signature) 17 <br /> Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) � Date[Tlme <br /> i <br /> Dispatched by (Signature) Date/Time ce d f borator by ,o DatelTfine <br /> d I(wM. <br /> Method of Shipment Laboratory Name <br /> Special instructions I hereby author a pert rm nce of the above indicated work <br />