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Nov f• � <br /> t Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnviron mental, Inc Date -�� Page of <br /> 4005 North Wilson Way-Stockton California 95205 (209)467 1006 Fax(209)467-1118 <br /> Client Protect Manager // <br /> Tr 11,1 C k r !(rt Tests Required <br /> Phone Number , f r /1( <br /> Samplers (Signature) \ t Invoice <br /> Project Name TO Irl f + �� �%, 11/4Cl✓�'�- ,V AGE <br /> Client p <br /> Sample Type <br /> Sample Location <br /> Date Time Water Solid No of �` Notes <br /> Number Description ComAir Conts ` <br /> p Grab <br /> ehnquis e y (Sgnat rel eceiv—ed y (9 ignature DatelTim <br /> Relinquished by (Signature) Received by (Signature] DatelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Dateftime <br /> Dispatched by (Signature) Date/time �lecew for Laboratory-�y 4 Af Dalefrime <br /> Method of Shipment Laboratory Name <br /> Special Instructions I hereby authorize the perfo ante of the above indicated work <br /> r <br />