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� • i <br /> Advanced CHAIN OF CUSTOD RECORD <br /> GeoEnvironmental, Inc. Date I1-k-03 Page �- <br /> 837 Shaw Road - Stockton, California- 95215- (209)467 1006- Fax (209) 467-1118 <br /> Client LUrr rProtect Manager Tests Required <br /> Din Kw l th, b it <br /> Phone Number <br /> LAo 7- <br /> Samplers (Signature) �.r" Invoice <br /> AGE 0S <br /> Project Name ClientLai ❑ <br /> I <br /> Sample Location Sample Type No of 1� 0 ., <br /> Number Description Date Time Water Air Solid Conts Notes <br /> Comp Grab <br /> AW I /Q-040 tvl L'J YZ >11 3 <br /> MW3/020 IW,'J 3 l3 Zc <br /> TW7Auiv -7 ///5 <br /> VW Izc v IJ x-19 tY3O <br /> e ujs e y (Signature) Received y ignature DalelTtma <br /> Relinquished by (Signature) tof Received by (Signature) Datefrime <br /> Relinquished by (signature) Received by Mobile Laboratory for field analysis (Signature) DalelTima <br /> Dispatched by (Signature) DalelTtme Received for laboratory by Patelfirria <br /> Method of Shipment Laboratory Name <br /> vt ` Cad T�6� <br /> Cal ovecv <br /> Special Instructions I hereby authorize the performance of the above indicated work <br /> •J <br />