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w■■r �� i flffffffl♦ is ftl! ff>♦ flfffffl! f!♦ i• i• i_ � � � � � <br /> ( Advanced CHAIN OF CUSTOD ECORD <br /> GeoEnvironmental, Inc Date Page ---L_ of—� <br /> 837 Shaw Road- Stockton, California- 95215 - (209)467-1006 Fax (209)467-1118 <br /> Client Prk <br /> t ani er <br /> �� � Tests Required <br /> one i <br /> Z' <br /> Samplers (Signature) Invoice <br /> Project Name AGE R< <br /> ��Rc4e-'e-e— rL y�- y Client ❑ <br /> Sample Location Sample Type <br /> Number Description Date Time water qtr Solid C n of <br /> �� Notes <br /> Comp Grab <br /> qL2 <br /> i <br /> e mquis e i nature Received by (Signature) 0 Ie1Ti <br /> Relinquished by (Signature) "� Received by (Signature) <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) � � Date/Time <br /> Dispatched by (Signature) Date/Time Received to Laboratory bys 1 to ime <br /> IoG::E%Y/!/� I �D3�I <br /> Method of Shipment Laboratory Name <br /> RLC'D SEALED& INTACT VIA C w <br /> Special Instructions t� 7 i hereby authorize the performart o! the above indicated worts <br /> l IWAD SPACE ABSENT CpTf fAINER5 �- <br /> DECULORINATED IN LAPRESERVED IN LAf_ <br /> PRESERVATION <br />