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� s <br /> [ Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvlronmental, Inc. � d • �o G" Date Page --. of <br /> 837 Shaw Road Stockton, California-95215-(209)V67-1006- Fax(209) 467-1118 <br /> Client Project Manager Testis Required <br /> Phone Number <br /> Samplers (Signature) Invoice` <br /> N <br /> Project Name J AGE <br /> Client ❑ <br /> Solid Type ype <br /> Sample Location No of <br /> Number Description Date T me Sample <br /> Water Air Cants ' '� Notes <br /> Comp Drab <br /> r <br /> i <br /> ' vZ- 9 <br /> ern e y nature ace ve y (signature) DatalTims <br /> Y'V <br /> R fished b Signa Received by oatef ime <br /> A r1_ ,�z a J N. <br /> Relinquished by (Signature) ;T AA,, )i tt Roa-&reed by 1I9 I <br /> r5'ralo4y for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time a ed or skioratory by DatelTime <br /> faG <br /> Method of Shipment , y aboratory Name <br /> J\Speclal Instruction I hereby authorize thi perlormance of the above Indicated work <br /> Coll'a �4 <br /> tel" <br />