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� � � � � � � � � � � I•� � ■�■■ tftftft� i■ <br /> ! o7 <br /> � Advanced <br /> CHAIN OF CUSTODY RECORD <br /> -_ of <br /> GeoEnvironmental, Inc. Date Page <br /> 637 Shaw Road- Stockton, California-95215- (209)467-1006- Fax(209)467-1118 <br /> Client Project Manager Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> Protect Name AGE NJClient ❑ <br /> Sample Location Date Time Sample TypeWater Solid No of /q Notes <br /> Number Description Air Cont <br /> comp Grab s <br /> -� t-A I e7 <br /> _to 3z X <br /> t( _ q 33 <br /> t �L70 X I K <br /> e inq ils-hed by ( n lureeceive y ignature Dalem�701D is loll D 2- <br /> Relinquished by (Signature) Received by (Signature) 6aterrtme <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Received for Laboratory by { Date/Time <br /> j Z <br /> Method of Shipment 1 Laborator Name , <br /> Wl 'p_C- �' <br /> Special Instructions I hereby authorize the performance of the above indicated work <br /> 7 V'LJ"k1' <br /> C <br />