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1• 1• � � � � l• � � � i• � !• � ti■ � �� �■ tri <br /> s • i <br /> Advanced CHAIN OF CUSTODY RECORD <br /> Date 6�S'"°� mage J_ Of <br /> GeoEnyironmental, Inc, <br /> 837 Shaw Road- Stockton, California-95215- (209)467-1006- Fax(209)467-1118 Q G ` <br /> Client �'� Proj Ma ge li <br /> Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> Project Name �/� , ��j �� AGS ❑ <br /> Pj-edei1-11 es �'` Client ❑ <br /> Sample Location Sample Type No of <br /> Number Description Date Time Sample <br /> Water Air Conts ,G� `Q0 <br /> Comp Grab f \ <br /> 7 '1P_f1 21)0� 4-r 70 6-x'7-v 3 10'Y-7 <br /> r►�,s <br /> iLlal 9 ej lam► �� ,y l / / <br /> x4130 <br /> Rellp4ulshed by (Signature) _ ecerve y ignatura Date/Time <br /> Relinquished by (Signature) Received by (Signature) Date/Time <br /> I <br /> elc <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatelTime <br /> Dispatched by (Signature) Date/Time Received for Laboratory by Date/Time <br /> 2r-o -2 <br /> Method of Shipment � CL <br /> La a <br /> Special Instructions I hereby uthorize the performance of the above Indicated work <br />