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CHAIN:OF;CUSTODY RECORD <br /> Advanced = <br /> Date % ` ' .. Page of <br /> GeoEnvironmental, Inc. <br /> 837 Shaw Road - Stockton, California-95215- (209)467-1006- Fax {209)467-1118 <br /> Client - Project-Manager-, t <br /> 5. Tests Required <br /> fi <br /> Phone Number <br /> , w - ' Invoice: <br /> "7 _ Samplers: (Signature) <br /> r AGE E]' <br /> Project Name Client ❑ <br /> tet.—E + ':•t.'i �. r•e j ^R. :Sti •��' ! <br /> Sample Type <br /> Sample Location <br /> Date Time Water Solid No. of °` Notes <br /> •-\r, of Y'o <br /> Number Description Comp. Grab. Air Conts. �` <br /> Xj E <br /> Y <br /> eeiinquis e, y: (Signature) Received by: ignature f3atslTime <br /> Relin uished b Si nature Received b (Signature) a DatelTime <br /> q Y� l g ) Y� S ) <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Datef rime <br /> 4 <br /> �s d' <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Date/Time <br /> Method of Shipment: Laboratory'lVame <br /> Special Instructions: I hereby authorize the performance of the above indicated work. <br />