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CHAIN OF CUSTODY RECORD j <br /> � Advanced Date �� Page �fat � <br /> --- GeoEnvironmental, Inc. <br /> 837 Shaw Road- Stockton, California-95215- (209)467-1006 - Fax (209)467-1118 01-I-04 7 <br /> Client T Pr=Manager Tests Required <br /> Phone Number <br /> "77 — r <br /> Sampl (Signature) Invoice <br /> AGE Z <br /> Project Name CI ent <br /> p ❑ <br /> Sam le Location Date Time Water a Type Solid No of � <br /> Notes <br /> Number Description Gamp Grab Air Conts <br /> r, <br /> Xll <br /> ze->'��Ie�6�2 <br /> J V T <br /> TOGDJ70050L <br /> e mqu y ig tura) ecerve y ignature atelTima <br /> /Cort <br /> Rehn ed by ( —Ig na ura) Received by (Signature) date/Tlma <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatelTime <br /> Dispatched by (Signature) Date/Time Received for Labo cbyry Date/Time <br /> )O1 <br /> Method of Shipment Laboratory Ka r <br /> Special lnsliuclio s I hereby authorize the performance of the above indicated work I <br />