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(� 01 <br /> j� Advanced CHAIN OF CUSTODY RECORD <br /> --- Date G-/'I C"I Page _� of <br /> GeoEnvironmental, Inc. <br /> 837 Shaw Road Stockton, California - 95215 - (209)467-1006 - Fax (209) 467-1118 <br /> ClientProject Manager <br /> S <br /> Client )C- TestsMuired <br /> Phone Number <br /> Sampler . (Signature) b Invoice: <br /> Pct Name AGE ®. <br /> c <br /> i Q <br /> i�erc' K'?e (') a r i - Client ❑ <br /> Sample Location SamiftType No. of �.�', <br /> Number Description Date Time Water Solid a Notes <br /> p Comp. Grab. Air ContS. .fry <br /> \ <br /> S� Ici�c ��e�. �u�. �n:►.,��,i- ici �- Ilyti X s � h •x X 1�L 1 <br /> Ll <br /> S� Ic yc CI 5iv,� �� 1�3 X- X i lr{` <br /> T 1 lol'tC} &c �;� 1 1 �` �` x x y` 'L 1 L L`) <br /> e qu y: ( ignature) eceive y: ognature Date/7ime <br /> ,� /0 i /U 630 <br /> i wished y: (Signature) Recbive by: (Sign atur M I k�} C.t(u�k h its iDat ime <br /> %�, <br /> c" vt <br /> Relinquished by: (Signature) ewed y Mobile L borstory for field analysis: (Signature) D te/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Date/Time <br /> Method of Shipment: Laboratory Name <br /> 1 �rntc <br /> Special Instructions: J I hereby a horize the perform nce of the above indicated work. <br />