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(; L Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental Inc. Date _ •�..�,S page of <br /> 837 Shaw Road- Stockton, California- 95215 - (209)467-1006 - Fax (209)467-1118 p <br /> Client A�r G� $�,�tt ProjectMi 3age�{ � j�� Tests Required <br /> Phone Number <br /> Lfbi ` «()& <br /> Sampl s: ignature) n Invoice; <br /> `1 AGE ❑ <br /> Project Name � �}n d t Client 114 <br /> Sample Location Date me Samp Type <br /> Time <br /> Solid No. of Notes <br /> Number Description Water CoAir Conts. <br /> mp. Grab. <br /> Sbte c <br /> S4�Z/oat 1 � <br /> 3, 'fa <br /> Re n ure eceive y: (Signature) Date/Time <br /> quished by: (Signature) Received by: (Signature) Datelrime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Dato/Time <br /> Dispatched by: (Signature) DatelTime Received for Laboratory Dr- atelTi eek <br /> Method of Shipment: Labor ry Name <br /> J 42T <br /> Special Instructions: I here y thorize the erformance of the above indicated work. <br />