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( _ Advanced CHIN OF CUSTOD RECORD <br /> - = GeoEnvironmental, Inc. Date I��� Page g —° a--- <br /> 837 Shaw Road -Stockton,California-95215- (209)467-1006- fax (209)467-1118 <br /> Clientf� Project Manager <br /> e-5 5I " Lh i �- — , Tests Required <br /> Pho a Number <br /> Samplers: (Signature) Invoice: <br /> Project NameAGE <br /> � 7 <br /> 1 [� <br /> g � Client ❑ <br /> (J <br /> Sample Location Sample Type Date Time Water Solid Na. of Notes <br /> Number Description Comp. Grab. Air Conts. <br /> � CD-1a _.,-'" VIS j 1 f S - �v 3 1,4> {/ '3 ' <br /> e mquis a y: lone urs eceivs y: gnature <br /> DetefTime <br /> Relinquished by: (Signatur Received by: (Signature) f' DatefTime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) DatefTime <br /> Dispatched by: (Signature) Date/Timeeceivad for Laboralo by: _ DatefTime <br /> C� <br /> Method of Shipment: : Labor 9ry Name,, <br /> ill�Ll -C� G� <br /> Special Instructions: I hereby authorize the <br /> performance of the shove Indicated work. <br /> WE—J <br />