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t� t� ti ti � t� ffifffiw fifiiiiw fffflw liiiiifii■ w w w w ftftftfw w lta� es e�w <br /> I <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date '' Page -� of <br /> 837 Shaw Road-Stockton, California-95215-(209)467-1406- Fax (209) 467-1118 <br /> Project Manager <br /> Client ���� Tests Required <br /> Phone Number <br /> Samplers (Slgnatur Invoice <br /> Project Name & <br /> C-\, <br /> ' "` � �' <br /> AGE <br /> Cllent ❑ <br /> Sample Type <br /> Sample Location Date Time Water solid No of �1! Notes <br /> Number Description Comp Grab Air Conts <br /> w7 � � x <br /> Auxab (J) LtLAI X <br /> t- KkW co�-- \17073 Ile- <br /> aA�Jss natu ecewa y ignature oatelT�me <br /> 1091kcx-( I i ta r:� <br /> Relinquished by (Signature) Received by (Signature) Datelreme <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysts (Signature) � Qatef ime <br /> Dispatched by (Signature) Oalefrime Recew■d for Laboratory by Dateff e <br /> Method of Shipment � l Labor■ y ame L <br /> Special Instructions C ~" ��.6Z I hereby ■ her[ZG the performance of the above Indicated work <br />