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[ C C C [ [ [ C [ [ [ [ [ [ [ f f C [ <br /> j Advanced CHAIN OF CUSTODY RECORD <br /> --__ Date ` Page � of <br /> GeoEnvironmental, Inc. <br /> 837 Shaw Road - Stockton, California-95215 - (209)467-1006- Fax (209)467-1118 1 <br /> Client Project Manager <br /> Ll Tests Required <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> Project Name AGE <br /> Do Liu �,,6Cev­k. Client <br /> Sample Type ' <br /> Sample Location Date TimeNo. of <br /> Number Description Comp. Grab.Water Solid Air Conts. Notes <br /> _ �u <br /> elin s ed y: Signature) ecery \DateTirne <br /> Relin uishe y: (Signature) Received by: (Signature) Date/Time <br /> Relinquished by: (Signature) Received by Mobile laboratory for field analysis:(Signature) Date/Time <br /> Dispatched by: (Signature) Date/TimeReceived for Laboratory b�r: Data/Time <br /> J n„s �. t 2_3 <br /> Method of Shipment: Laborator Nam <br /> Special Instructions: I reby authorize the performance of the above indicated work. <br />