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I <br /> ( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. pateI A- `' Page -- I of <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-4006-Fax(209)467-1118 <br /> �- ,. , Project Man er <br /> Client � � .� .�'° '`� 4,1 <br /> Tests Required <br /> t -1Phone Number <br /> t. <br /> amplers: (Signature) +a ` invoice: <br /> P o ecName <br /> _ '-�� 'r AGE ®•- <br /> r 1 t Name � j ; Client ❑ <br /> � E <br /> Sample Location <br /> Sample Type � <br /> No, of v <br /> Number Description Date Time Water Air Solid Conts, Notes <br /> Comp. Grab. K{ <br /> I-lot- 0,41 <br /> l! <br /> �- r - t �` <br /> i <br /> -Re inquis a ignat a Received y: gnature Datelnme <br /> 7 <br /> Rallnquished by: (Signature) . Recelved by; (Signature) Daleffime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date rime <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by; F DatelTime <br /> Method of Shipment: a Laboratory Nape � <br /> U U4. <br /> Special Instructions: I hereby aLthori;e the performance of the above indicated work. <br />