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taw � � �� � � 1• i• � � i♦ � � t� � � <br /> � *Advanced <br /> CHAIN OF CUSTODY WORD <br /> GeoEnvironmental, Inc. Date 9 Z3 g Page i of ° <br /> 4005 North Wilson Way-Stockton,California-95205 (209)467-1006-Fax(209)467 111 a ci <br /> Client Fzk'V 1 L-1-- Z-1'(1aaR Z-/'(1a <br /> Project Manager Tests Required <br /> 10- -04c-rC4 <br /> Phone Number <br /> Zoe `7 —/dr <br /> Samplers (Signature) Invoice <br /> Project Name AGE <br /> L �U� Client ❑ <br /> Sample Location Sample Type No of <br /> Date Time Water Solid f� 4� Notes <br /> Number Description Comp Grab Air Conts <br /> I <br /> e r�u s e ( nature ace ve y Tvanature � � � Da e/Time <br /> Cg3 <br /> Retmq ted by (Signature) Received by (Signature) ' ate/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Dale/Time <br /> Dispatched by (Signature) Dale/Time Received for Laboratory by Date rime <br /> Method of Shipment r Laboratory Name Mc <br /> /+ <br /> L <br /> Special Instructions � � � n J � it � { hereby authorize the parlorm nca al the above indicated work <br />