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I <br /> 0 <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date ljpsl Page ot �-f <br /> 837 Shaw Road - Stockton, California- 95215 - (209)467-1006 - Fax (209) 467-1116 <br /> Client ` i l Project Manager <br /> —T�kTests Required <br /> Done umber <br /> mplers (Signature Invoice <br /> Protect Name �Ci� ����� ��� � AG <br /> Client ❑ <br /> Sample Location Sample Type <br /> Date Time Water Solid No of Notes <br /> Number Description comp Grab Air Conts .� <br /> t40.44A tib► <br /> MWS <br /> Re us a ig Receivedy (Signature) �7—D�atafT me <br /> LA <br /> RebATuished by—(Signature) Received by (Signature) Datefrime <br /> i <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis ature) Date[Tims <br /> F <br /> Dispatched by (Signature) DatefTime Receive 1Pf Lab4fat4ry <br /> b Da s/Time <br /> �Qc <br /> Method of Shipment � ��^ ,� _ Laboratory Nam i <br /> Special instructionst �= I hereby Drize the performance of the above indicated work <br /> , Pb <br /> I <br />