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tft� f, f� � � � 1• � � !• 1� � � t� ti t� t� t� t� <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date z' Page — - �-� <br /> 837 Shaw Road-Stockton, California-95215- (209)467-1006 Fax (209)467-1118 <br /> Client �. CS CA Protect Manager <br /> F- �C �— Tests Required <br /> Cv <br /> Phone Number <br /> Z �1 9 b o� v <br /> Samplers (Signature) Invoice <br /> Protect NameAGE <br /> lz—lmm,' Nt I <br /> - --1 I` Client j <br /> Sample Location Date Time Sample Type No of ,�Q�� -�� <br /> Number Description Water Air Solid Conts / PV Notes <br /> Comp Grab <br /> 1 SA4K <br /> 4W\V-7. A c ! r, n AT ZS ' 67—zQ3 "IX 5 I't y kk I <br /> 1+ lr tt �i <br /> V-1 T 3syx <br /> ? r <br /> `` S ,► <br /> 47 ST " � r q e <br /> Be inquts e y ignaturelRecelvedyrgnature <br /> _ OatelTime <br /> 07 ZZ ,3 V�it0A, <br /> Relinquishedby (Signature) Received by (Signature) r 7, ate/Time <br /> Relinquished by (Signature) Received by Mobde Laboratory for field analysts (Signature) DatelTtme <br /> Dispatched by (Signature) Date/Time Recaiv , for Lab9 o by Date/Ti e <br /> nZ '� Z <br /> Method of Shipment Laboratory Name �J <br /> CA S AIe-"n f�, CIL 1 _ � � C. e- <br /> special Instructions 1 hereby authorize the performan a of She above indicated work <br /> X411 A b avim. C a e*� +,.e A <br />