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( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Dare �' 2Z-L3 Page - of A- <br /> 637 Shaw Road - Stockton, California- 95215 - (209) 467-1006 - Fax (209)467-1118 <br /> Client d Project Mana er T <br /> � ]qj � L r Tests Required <br /> 'I I IL <br /> Phone Number <br /> "'f&l jd3C-, <br /> Samplers (Signature) ; Invoice <br /> Project Name ti j j X�� 4'� P5- <br /> Client El <br /> Sample Location Solid Notes <br /> Sample Type No of ,. .� "1� <br /> Number Description bate Time Wa1er Air Conts <br /> Comp Grab 1 <br /> / /I / <br /> I <br /> L31 f•I r�vh► `� � � • / <br /> JM W IR <br /> e nq is e y Jgnature) Received by DatelTime <br /> Relinquished by (Signature) Received by (Signature) Date/Time <br /> Relinquished by {Signature) Received by Mobile Laboratory for held analysis (Signature) Date/Time <br /> Dispatched by (Signatufe) Date/Time Received for Laboratory by Date/Time <br /> Method of Shipment Lab tory N me <br /> Special Instructions i hereby authorize the performance of the above Indicated work <br />