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i <br /> Advanced CHAIN OF CUSTOD ECORD <br /> GeoEnvlronmental, Inc Date �- 23�� Page 3 �� <br /> +, 837 Shaw Road Stockton, California-95215 - (209) 467-1006 - Fax (209)467-1118 <br /> Project Manager <br /> Client .—� Tests Required <br /> Pone tuber <br /> Lt U2-7— c� � <br /> Sa rs (Signature) Invoice <br /> AGE <br /> Project Name / U� } Client ❑ <br /> Sample Location Sample Type Solid No of <br /> Date Time Water N Notes <br /> Number Description Comp Grab Afr Conts <br /> lJt�t3 fTZ�+=t1lZ-t3 12 t316u 1Cj-lLQ <br /> ehngws �( n <br /> Received y (Signature) Delefrime <br /> -GLl <br /> in is Sig re) Received by (Signature) /� Date(Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) _ / ► 7- Dateffime <br /> Dispatched by (Signature) Date/Time Received for Laboratory by ✓ `` Date/Time <br /> Method of ShipmentC-OA o " Laboratory Name <br /> 0i here uthorize the p ante of the above indicated work <br /> Special instructions if-Cl4 <br />