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CHAIN OF CUSTODY%CORD <br /> Advanced Date � Pae � of—CL <br /> _ - GeoEnvironmental, Inc g <br /> ~ 837 Shaw Road - Stockton California- 95215 (249) 467 100& Fax (209) 4671118 <br /> Clientc t Pro ect Manager Tests Required <br /> �ifl` ' C �-- <br /> P one N tuber <br /> Samplers (Signature) / Invoice <br /> AGE <br /> Prolect Name t Client ❑ <br /> Sample Type <br /> Sample Location Date Time Water Solid No of i / Notes <br /> Number Description Comp Grab Air Conts <br /> ITZt <br /> Xx <br /> L-,' t, - <br /> \W m <br /> ln �- 1 <br /> e rnquis e { ignature) ecewe y t`gnature DatalYa t <br /> Reiinquished by ignaturc) Received by (Signature) Datio fame <br /> Relinquished by (Signature) Received by Mobile Laboratory for field anatyam (Signature) DatefTime <br /> Dispelched by (Signatu(e) Dateffirrme Rac d o aboratory b ` / Date <br /> Laboratory Name / <br /> Method of Shipment f L/ <br /> Special instructions I hereby authorize the pertorman a of the above indicated work <br /> JED <br />