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� I• � � � � � IIII• fill• � �� � I•■■ tfw� titttttlttiil titiitttt>f ttttlittt� <br /> • s • <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. <br /> Date Page --a of <br /> 837 Shaw Road- Stockton, California 95215- (209)467-1006- Fax(209) 467-1118 10- 00-3 O- dp-3 <br /> Client `�� �.lh , Pratr�an Manager Tests Required <br /> Phone Number <br /> Somplers (Signature invoice <br /> Protect Name - AGE <br /> C'�� �,� / Client ❑ <br /> Sample Location Sample Type No of <br /> Date Time Water Solid Notes <br /> Number Description Comp crab Air Conts <br /> AWJk�� <br /> i <br /> DatelT e <br /> rn urs e i nature ece va y rgna ure iv&4 <br /> le <br /> Re rngwshed by (Signaturay Received by (Signature) I DatelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> i <br /> Dispatched by (Signature) DatelTime Received for Laboratory by . Date/Time <br /> oAll <br /> Method of Shipment LAD ry Flatt}� Via <br /> Spacial Instructions I h y sutli the performs a above indicated work <br />