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_ ( Advanced CHAIN OF CUSTODY RECORD <br /> Date ?.'n,� page 4of� <br /> --- GeoEnvironmental, Inc. <br /> - — 837 Shaw Road-Stockton, California-95215 - (209)467-1006- Fax (249)467-1116 <br /> I <br /> Project Manager Tests Required <br /> U <br /> Phone Number <br /> - Ak7f 1006 <br /> Samplers (Signature) Invoice <br /> AGE <br /> T <br /> Project Dame41 <br /> � �[, - I�' Client ❑ <br /> Sample Location Sample Type No of ! <br /> p Date Time Water Solid 4 ti Notes <br /> Number Description comp Grab Air Coms <br /> 11t ►t ,,�i,,3IZL l+ Cf 32_ ( r / <br /> IZ ei j 2 3 <br /> V/t t <br /> _ =pj-tvd r3 11 t,%,f 13 N �� l <br /> e uis e2b Received by ignature Date Time 1 <br /> � I13 lEc'rl <br /> Relinquished by (Signature) Received by (Signature) Date(Tlme <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Received for Laboratory by DatelTim <br /> a* <br /> Method of Shipment t ',^ La story Name i <br /> i; <br /> Special Instructions r� `1 ._ �� 1 hereb authorize the performance of the above Indicated work <br />