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or .. mI Sla Ul <br /> Advanced <br /> CHAIN CUSTODY RECORD <br /> j f <br /> =_ GeoEnvironmentab Inc, Date Page of <br /> 4005 North Wilson Way-Stockton,California-95205 (209)467-1006-Fax(209)467-1118 <br /> Client P Project Mana er _Vlrests Required <br /> Phone N mber� <br /> I <br /> lers (S nature) Invoice <br /> Project Name AGE <br /> Client ❑ <br /> Sample L c iol Date Time Sample Type Solid N o of <br /> Notes <br /> Number Description Water Air <br /> Comp Grab <br /> Nill/a/ <br /> e inq is e y ;on tui Rec4010 y ion re WV-01 <br /> tefrimeRelin eshe by Sign Re ed y {SignetteFfime <br /> Relinquished by ( nature) Receive y Mobile Laboratory for field analysis (Signature) DatalTima <br /> i <br /> Dispatched by (Signature) DatelTime Received for Laboratory by DalelTime <br /> Method of Shipment Laborato Name <br /> Special Instructions i hereby onze the erform ce of the above indicated work <br />