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� � � � � � r � � I• � kl• klf, Illlllllllk, IIIIIIII�D� � _>_ IItt1� <br /> j <br /> CHAIN OF CUSTOD ECORD <br /> Advanced <br /> GeoEnvi'onmental, Inc. owe V -�-� Page 1 <br /> 837 Shaw Road-Stockton,California-95215- (209)467-1006- Fax(209)467-1118 <br /> Project Manager <br /> client � � �� `us Tests Required <br /> .. � � <br /> Phone Nu r <br />� �U� <br /> Samplers: {Signature} f Invoice: <br /> {� AGE <br /> Project Name kU CA) �Q� - <br />� 1 L� .^ , �` Client ❑ <br /> Sample Location <br /> Sample Type �L . <br /> No. of <br /> Number Description Date Time Water Air Solid Coms. Notes <br /> Comp. Grab. <br /> 29 <br /> -A X, <br /> is a y: ( ignature ece ve y: ignature Date/Time <br /> Cis �-c7> <br /> Re'fir4uished by: (Signatufe) Received by: (Signature) T ,IL Daterrime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for lield analysis:(Signature) !f`�I Dale/Time <br /> Dispatched by: (Signature) Date/time Received for Laboratory by: Det /Time <br /> 8;30� e � ' <br /> Method of Shipment: Laboratory�� <br /> Special Instructions: I hereby authorize the performance of the above Indicated work. i <br />