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s <br /> ( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date o7 °,43 Page Z ov3 <br /> 837 Shaw Road - Stockton, California-95215- (209)467-1006 - Fax (209)467-1118 <br /> Client A is) JD D Protect Manager <br /> U e-)Al. Tests Required <br /> Phone Number <br /> 05 96 <br /> Samplers (Signature) 4. Invoice <br /> Protect NamePAC <br /> i &$x <br /> AG/r�v�) �, Client ❑ <br /> Sample Location Sample Type No ofQ <br /> Number Description Date Time Water Air Solid nts � <br /> Notes <br /> Camp Grab <br /> �I <br /> �j "� p X43 ►: �5 S �� � <br /> f r ' rr r it 5" <br /> P8'- errAl .5ei <br /> 1 ) ,ov <br /> r IS <br /> /r /r it f/ �-1�� <br /> 2 ,0 T 2 CI; <br /> e guise y Sign a ec ive y -(Signature) 2D WITrme <br /> ei guished by (Signature) Received b (Signature) ' 'J �� T F yr� <br /> Y ( 9 )I.- 5 T4 � � Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for held analysis (Signature) DatelTima <br /> Dispatched by (Signature) Date[Time eived or L borat r by D elTime <br /> Lo �2 <br /> Method of Shipment r .�. L ato y Name ) <br /> 0�)E.ML CH // M1 <br /> Special Instructions I hereby authorize the performance of the above In icated work <br />