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• i • <br /> [ Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvl<ronmental, Inc. Date 7JL —3 Page sof <br /> °-� <br /> 837 Shaw Road- Stockton, California- 95215- (209)467-1006- Fax (209)467-1118 Q ! f <br /> Client ` V� I <br /> Project Mana er Tests Required <br /> 2 L <br /> Phone Num r(am Yt 7—In <br /> Samplers (Signature) lnvoice• <br /> AGER <br /> Protect Name �Ct � �� � �, �'' Client ❑ <br /> Sample Type <br /> Sample Location Date Time Water Solid NO of Notes <br /> Number Description Comp Grab Air Conts <br /> MOOD, D t � <br /> 7 <br /> Lfi <br /> Iv <br /> e in��.dby <br /> i lure ecewe y �gnature °ate/Time <br /> �( -7-17-43 d <br /> Relinguis (Signature) Received by {Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatelTlme <br /> Dispatched by (Signature) Date[Time Received for Latiorat by Date/Time <br /> Method of Shipment , boratory Name <br /> LA �� ak <br /> Special Instructions f I hereby authorize the performance of the above indicated work <br /> I . <br />