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�r r r r ,, r rr r r r r r r r ■■r r r� r r <br /> J <br /> ( Advanced CHAIN OF CUSTODY RECORD <br /> � � � - <br /> GeoEnvironmental, Inc. r <br /> Date Page ` of <br /> 837 Shaw Road-Stockton, California-95215 - (209)467-1006 - Fax (209) 467-1118 ,r 1 <br /> ClientProject Manager 1 <br /> Tests Required <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> Project NameG� f AGE Ia- <br /> Client ❑ <br /> • Sample Location SampEs Type Solid Notes <br /> No. of / <br /> Number Description Date Time Water Air Conts. <br /> Comp. Grab. <br /> l�tiU as�o �� B u -y' <br />�,'W \Aj Z <br /> I�vtw IMS <br /> Re �n is a y: ( ecerve y: rgnature Date/Time <br /> o. [ Ip <br /> Relinq ed by: (Signature) Received by: (Signature) Date rime <br /> Relinquishedby: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/time <br /> u l gz� <br /> Dispatched by: (Signature) Date/Time Received for Laborato Dale/Tirrie <br /> Method of Shipment: %�"•C rU oratory Name <br /> Special Instructions: �t I here authorize the performance of the ab ve indicated work. <br />