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CHAIN OF CUSTODY RECORD , <br /> j Advanced Date '� 1` rtZ Page —I_ of - <br /> --- GeoEnvironmental, Inc. <br /> - ��- <br /> 837 Shaw Road Stockton, California 95215 (209) 467-1006 - Fax(209) 467-1118 <br /> 7— t5 <br /> Project Manager '� Tests Required <br /> Client 114 i- 7: ► '�5 r / <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> AGE <br /> Project Name n 1 <br /> Client <br /> Sample Type No. of <br /> Sample Location Date Time Water Solid Notes <br /> Number Description comp. crab. Air Conts. <br /> �y <br /> oLJD <br /> I <br /> 11040 <br /> i. <br /> -1" <br /> e�rrgnt ( ecee y: ignature Da [Time Time <br /> shed by: (Sgature) L <br /> ( ' <br /> ate/Time <br /> Reli quished by: (Signature) Received by: (Signature) ,, l,• 11 - <br /> Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) <br /> Date/Time Received for Laboratory by: J Date/Time <br /> Dispatched by: (Signature) _ 7_ <br /> /d: 0 <br /> L or Tory Name <br /> Method of Shipment: <br /> L" <br /> I hereby authorize the performance of the above indicated work. <br /> Special Instructions: <br />