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i • • <br /> ( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date ��� <br /> 837 Shaw Road - Stockton,California- 95215- (209)467-1006- Fax (209) 467-1118 <br /> Client Pr ect Ma na e <br /> Tests Required <br /> ,hone m r <br /> ter( �C7-lb�� <br /> Samplers (Signature) Q Invoice <br /> Protect Name <br /> AGE <br /> Client ❑ <br /> Sample Type <br /> Sample Location 5011 No of � Notes <br /> Comp Grab <br /> Number Description Date Time Water Air Conts <br /> (Z/3* lo 3 <br /> M� GG <br /> t--S <br /> J 4 <br /> e inquis a ignature) ace yed by rgnatur-a Da a/Tim <br /> Relinquished by (Sign tura) Received by (Signature) Date/Time <br /> Relinquished by {Signature) Received by Mobile Laboratory for field analysis (Signature) ` � Date/Time <br /> Dispatched by (Signature) Date/Time Raceived for Laboratory by1 Date/Time <br /> PC,- � � _ 7— / 11-f 90 ) <br /> Method of Shipment Laborato ame C <br /> Ol�� ltit� —6- C <br /> Special Instructions �( s J�t� ?1 l01 i hereby authorize the performance of the above indicated work <br /> z-36 <br />