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COC)QOC <br /> ( Advanced CHAIN PF CUSTODY RECORD <br /> GeoEnvironmental, Inc Date Page of <br /> 837 Shaw Road Stockton, California 95215 (209)467-1006 - Fax (209) 467-1118 <br /> ClientPro ect Man r <br /> _��' . � �J r._. Tests Required <br /> Ppone umber <br /> X167 1019(o <br /> Samp fz (SI tore) Invoice <br /> Protect Name / I�� <br /> AGE <br /> CA te, /" �C Client ❑ <br /> Sample -Location Sample Type Noof <br /> Number Description Date Time Water Air Solid Corns a Notes <br /> Comp Grab <br /> f -061 &L <br /> r � 7Sr <br /> t J; _ci(o 'Lr-Z_ <br /> a i qu shed y (Signature)- Aecety by g ure) DaterTime <br /> Reh quillby Signa Received4y ( ignalu}eY� D e/Time <br /> Rehnqutshed y (Signal re) Received by Mobile Laboratory for held analysis (Signature) ' date/Tim <br /> Dispatched by (Signature) Dale/Time Received for Laboratory by DatelTime <br /> Method of Shipment r} C - _ I Laboratory VmoA�f <br /> l,Ju 0&0 UZTAIa On= g �-1� G <br /> Speclal lnslruclions ICFJt' FRESIMMWNI hereby authorize the p formance of the above indicated work <br /> GOOD CONDMON APPRt3FATA " <br /> preen�pertr <br /> DECI 1,0111NATED IN LAB PRESET11' ' ' �e(A <br />