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80 tl� � � t• w til• � Ir � <br /> ( Advanced 2 _ CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date of Page __ _ — of <br /> IAL <br /> 837 Shaw Road - Stockton, California 95215- (209) 467-1006- Fax (209)467-1118 <br /> Tient Project nager Tests Required <br /> (moi CA i G►► <br /> Phone Number <br /> Samplers (Signature) x Invoice <br /> )rolect Name AGE <br /> Client ❑ <br /> Sample Location Sample Type No of <br /> Date Time Water Solid � Notes <br /> Number Description Comp arab Air Conts <br /> CM " J -% IJ 1401 13X1 x fe3 <br /> G I- -Ili )'j'jgjj Igco �r <br /> I I tip«' 1< <br /> (I X <br /> e rnquis e y rg re ece e y ignature �� S � T � Date/Time <br /> Relinq&�' <br /> by Signature) Received by {Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for lield analysis (Sig Date/Time <br /> Dispatched by (Signature) Date/TimeReceived for Laboratory by DatelTtme <br /> Method of Shipment Lab o ory Name <br /> ot, even'( C,1 -reC <br /> Special instructions I hereby authorize the performance of the above fndtcated work <br />