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1• � � � l• � � � � � � � r � l• Ii t• <br /> ( Advanced <br /> CHAIN OF CUSTODY RECORD <br /> -T GeoEnvironmental, Inc Date °`� Page of� <br /> 837 Shaw Road- Stockton, California 95215- (209) 467-1006 - Fax (209) 467 11118 <br /> Client , � Project M nagen <br /> V%dkC Tests Required <br /> P one tiumber <br /> Samplers (Signature) �C/ Invoice <br /> Project Name U AGE X <br /> C1 49000, 1 � Client ❑ <br /> Sample Location Sample Type No of N <br /> Date Time Water Solid � Notes <br /> Number Description Comp Grab Air Conts � <br /> Ale <br /> �4 ©V21t ; g <br /> e a y rgnaturey ecewe y ignalure Da /Tim <br /> Zad <br /> Relinquished by (Signature) Received by (Signature) Dale(Tt to <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) T DalefTime <br /> Dispatched by (Signature) Datel7ime Received for Laboratory by Date/Time <br /> -- <br /> Method of Shipment over Laboratory Name <br /> c�1 t\ <br /> Special lrstturtions I hereby authorize the performance of the above Indicated work <br />