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t� � liffffffff� �� � �■t>• t>_ lffffffffff■ t>_ tt>_ � �� i•� �■� �� �� ■� <br /> Advanced <br /> CHAIN OF CUSTODAECORD <br /> � � ��65- � <br /> GeoEnvironmental, Inc. Z—� Date Page �. � <br /> 837 Shaw Road- Stockton, California-95215- (209) 467-1006 Fax (209) 467-1118 <br /> Client r Prol Manager <br /> O VArn,� ��� Tests Required <br /> PhgneNur�r'� <br /> amplers (Signature Invoice <br /> Protect Name G L AGEtClient �❑ <br /> i 1 r <br /> Sample Location <br /> Sample Type <br /> No of // <br /> Number Description Date Time Water Air Solid Conts h '� Notes <br /> Comp Grab <br /> L <br /> elinquis y ( ignalure) ecesve ySignature) Daleefrrme <br /> 101— <br /> 01 1 <br /> Relinquished by (Signature) Received by (Signature) ,�] �.{� DatefTime <br /> Relinquished by {Signature) Received by Mobile Laboratory for field analysis (Signature) J DatelTime <br /> Dispatched by (Signature) Datefrtme Race r Lab rator y D iffirne <br /> �Z Irf r7 SL L� 6 <br /> Method of Shipment ^� Laborato Nam v /� <br /> 4 Ove l c-C <br /> Special Instructions 1 hereby authorize the performance of the above indicated work <br />