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� � � � r• r• � I• II>II>II� � � � � � ttt(• � f• � � <br /> Advanced CHAIN OF CUSTODY RECORD <br /> =_ GeoEnvironmentai, Inc. a-7L/C ' Date z Page __L___ of <br /> 837 Shaw Road- Stockton, California-95215-(208)467-1006 -Fax (209)467-1118 <br /> Client Project Mana er <br /> Tests Required <br /> Phone Number <br /> 4)(o 4 <br /> S rs (Signature) Invoice, <br /> Protect Name / p AGE <br /> Z—Obl <br /> �C!" Client ❑ <br /> Sample LocationSample Type No of <br /> Number Description Date Time Water Air Solid Conts i Notes i <br /> Comp (arab <br /> //Co75684 <br /> I leii <br /> 75685 <br /> Zl <br /> 75686 <br /> zz0 75687 e <br /> y70 <br /> ys*t� lnrra^' 'r 11 pr <br /> a mqury isignature K61361ved by (Signature) D to <br /> Lam/ <br /> Relahmimea by natur Received by (Signature) _-r/4 ,7 DatelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Ra awed for Lfborator y DatelTime <br /> 936 <br /> Method of 5hipme labor ory Name <br /> Special Instructions l hereby auth Ize the performance of the above indicated work <br />