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� a <br /> i Advanced � CHAIN OF CUSTOD ECORD <br /> Date t -z Page 2 of <br /> --- GeoEnvironmental, Inc. <br /> 837 Shaw Road - Stockton, California-95215 - (209)467-1006- Fax (209)467-1118 <br /> Client V S Protect Mannm'C,r< C' Tests Required <br /> Phone tuber <br /> Zig C_t�C't C:J 4� Li <br /> Samplers (Signature) Invoice <br /> AGE <br /> Protect Name ._ „ rl _, � r� �' Client ❑ <br /> f`� /Sample Location Date Time SamWaterple Type Solid No of Notes <br /> Number Description Comp crab Air Conts . <br /> I � 121-t-16',41 tzz-Z' 3 k <br /> ,usF (-zs3 3 <br /> T— U—n <br /> -74 <br /> qu e y ( eceiva y ignawre Date/Time <br /> Re inquished by (Signature) Received by (Signature) DateTrime <br /> Relinquished by (Signature) Received by Mobile Laboratory for held analysis gnature) � Data(Time <br /> Dispatched by (Signature) DatelTima Recew d f bora ry by QatelTrme,�,�v <br /> y (V� <br /> Laboratory Nama <br /> Method of Shipment V <br /> i! lf+ I her uthonze the pe ante of he above indicated work <br /> Special Instructions , M_rip <br />