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iii � l� iii � � � I� � ■� l� i� I[s �■ ■r• � i� � iii <br /> Advanced <br /> CHAIN OF CUSTODY RECORD <br /> � f <br /> GeoEnvironmental, Inc. Date °� Page / o <br /> 637 Shaw load-Stockton,California- 95215- (209)467-1006- Fax(209)487-1118 C� <br /> Client Project Man er Tests Required <br /> P no Number <br /> 7. AV6 <br /> 6L,DU xz d 7` Q Samplers: (Signature) Invoice: <br /> Project Name Client ❑ <br /> K � <br /> Sample Location Sample Type No. of <br /> Number Description Date Time Water Air Solid No. <br /> Notes <br /> comp. (arab. J( <br /> DID- <br /> ! e r ws a y' ig slur sca ve y: gnature oa efT{ma <br /> �3�: ii; �vrt�es rcc:�we z <br /> R linquished by: (Signature) Received by: (Signature) �, �` I���Qip � ate/Time <br /> I <br /> Relinquished by: (Signature) Received by mobile Laboratory for field analysis:(Signature) Date/Time <br /> Dispatched by: (Signature) Dale/Time Re v or Labor o by: w3 Date(Time <br /> Method of Shipment: abora Name <br /> work. <br /> Special Instructions: I hereby authorize the performance of the above indicated <br /> I 1 <br /> i <br /> I <br />