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1• � � ■■■ � � � S � � t� tom■ f� t� �ntlfiff■i IfifittlttA <br /> I� U Advanced CHAIN OF CUSTODY <br /> RECORD <br /> GeoEnvironmental, Inc. Date 12- 7-9s Page of <br /> of Northern California <br /> 1803 West March Lane Suite A Stockton,California-95207-(209)956-0264 Fax(249)956-0700 <br /> Client Project Manager <br /> Tests Required <br /> t Q G <br /> Ph ne Number <br /> 9q cis � <br /> S plers (Signature) Invoice <br /> Project Name AGE PJ <br /> C( r Q 3� Client ❑ <br /> Sample Type <br /> Sample Location Date Time Watet Solid No of 4 Notes <br /> NuYnber Description Comp Grab Air Conts <br /> Amp" ndo-e- <br /> el quis e (Sig ature) eceive y (Signature DatetTime <br /> %74N0 IZ -8--95- 5,C)o <br /> elinquished by (Signature) Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Tsme <br /> Dispatched by (Signature) Date/Tlme Recei d fo a tory y D�q ; <br /> telTime <br /> Method of Shipment Lab o Irgyarae <br /> 0U rN, 64a( frC41 <br /> Special Instructions I hereby authorize the performance of the above indicated work <br />