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CHAIN OF CUSTODY RECORD <br /> Advanced Date 4 dd 3 Page of-L— <br /> GeoEnvironmental, Inc. <br /> B37 Shaw Road - Stockton, California-85215-(209)467-1006 - Fax(249)467-1118 0 r 0 � <br />- Clients Prot Mana Tests Required <br /> Phone Number <br /> Sam ers (Signature) Invoice. <br /> AGE <br /> Project Name 1 � rCr y Client p <br /> Sample Location Date Time <br /> Sample <br /> Type Solid No of ' Nates <br /> Number Description Air Conts <br /> - Comp Grab <br /> 040,5 t-tW <br /> 6 o�v,6 wtLf J;LA <br /> Alaig-L846,,at,c33 kr t-7 <br /> e inq a y ig tureReceive by (Signature) DatelTlme <br /> Relinquished by (Signature) - Received by (Signature) Date rime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date[Time Received for Laboratory by Date/Time <br /> Method of Shipment Labe ry e <br /> Special InstructionsOF I hexa authorize the performance of the above indicated work <br /> - AIC9 ' 7 0 6 f- <br /> � � <br />