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ttttt� ti�� ttl� iifiiifiii� fly � � r <br /> ( Advanced <br /> CHAIN PF USTODY RECORD <br /> GeoEnvironmental, Inc. Z_ 3-1�> Date Page <br /> 4 of—K <br /> 837 Shaw Road -Stockton, California- 95215- (209)467 1006 Fax (209) 467-1118 <br /> Client *' Project Mana er Tests Required <br /> IM <br /> P e Number �7 <br /> C <br /> Sa (S ure) 1� S Invoice <br /> Project Name " <br /> AGE <br /> Client ❑ <br /> Sample � Location Sample Type <br /> Date Time Water Solid No of � Notes <br /> Number Description Comp Grab Air Conts <br /> \."+W XX-' 19 per fj 4 <br /> e inquis Nzat <br /> re ecewe y ignature D te[T me <br /> ZZ <br /> Relinquis ure) Received by (Signature) Dat (Tir e <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Sign atur Date/time <br /> Dispatched by (Signature) Date[Time Received for L Pwgktoryjby Da /Time <br /> ! 3 0 4Z 43v <br /> Method of Shipment Laborato y Na r <br /> e <br /> Special Insiructions I hereby authorize performance of the above indicated work <br />