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� >, tf•Iw� � i•fll� ftp i � � � � � � � �� <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date Page <br /> 837 Shaw Road- Stockton, California- 95215- (209) 467-1006- Fax (209) 467-1118 0 <br /> Client Project Manager <br /> L J2, � � Tests Required <br /> one Number <br /> Safffnature) Invoice AGE Q/ <br /> rsVProject Name Client ❑ <br /> . Sample Type <br /> Sample Location No of <br /> Number Description Date Time Water Air Solid Conts Notes <br /> Comp Grab <br /> e inqu yig ure Receivedy ignature � ate <br /> Relinquished Uy ( nature) Received by (Signature) a e/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Sig natur Date/Time <br /> Dispatched by (Signature) Date/Time Received for bo t by , atelTim <br /> O-L-; <br /> Method of Shipment } LaboratName <br /> 06 - -e <br /> Special Instructions I herear <br /> performance of the above indicated work <br />