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t <br /> l Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvtronmenfal, Inc Date �'V Page �� of <br /> 4005 North Wilson Way-Stockton,California-95205 (209)467 1006 Fax(209)467-11113 �r 's� <br /> Cr I <br /> Client i Project Manager <br /> Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> �� <br /> Project Name AGFClient ❑ <br /> Sample Location Date Time Wa eple Type Solid No of /� �� Notes <br /> Number Description Air Conts <br /> Camp Grab <br /> IFf 5�.n}�lC V -)N -,SII f-1 TtD1,7R <br /> cls ir$L <br /> Relinquished y (t7l' <br /> ure) eceive y ignature) Date(rome <br /> 1 ryl -tom yt,� I �• f f- �'t <br /> Relinquished by (Signature) Received by (Signature) /Dale/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DalelTime <br /> Dispatched by (Signature) Date/Time Received for Laboratory-- y 9aterrime <br /> Method of Shipment Labofatory Flame <br /> t <br /> Lv,"i <br /> VQ rJ5pet ial Instructions I hereby authorize the performance of the adicaled work <br />