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i i i i i i i i Ii i i i i i i li i i Ii <br /> t Advanced CHAIN OF CUSTOD RECORD <br /> GeoEnvironmental, Inc. Date Page f of� <br /> 837 Shaw Road - Stockton, California- 95215- (209) 467-1006 - Fax (209)467-1118 <br />' Project Manager ClientRic. L g Tests Required <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> Project Name <br /> r 4 AGE <br /> ewM4d ClientSample ❑ <br /> J <br /> Type <br /> Sample Location Date Time Water Solid No. of Notes <br /> Number Description Comp. Grab. Air Conts. <br /> ICA LJ <br /> t - <br /> Z 4Lo <br /> r _ <br /> e tnq e n ur eceroe y: signature D te1Ti e <br /> Reiinquishe y: (Signature) Received by: (Signature) bate/Time <br /> Relinquished by: (Signature} Received by Mobile laboratory for field analysis:(Signature} Date/Time <br /> Dispatched by: (Signature) DatatTime R 'vad f r Laboratory by: Date/Time <br /> i t cz <br /> Method of Shipment: ,p � L tory.Nema <br /> ,� V =r/tlu <br /> Special In tructions: I hereby authorize the performance of the above Indicated work. <br /> EEL <br /> J <br />