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� 1• � � � I• � r� !• ri � �� � tit# 1� t� wl.s a.r■s <br /> � Advanced <br /> CHAIN OF CUSTODY RECORD <br /> - 4 'f� <br /> --- GeoEnvironmental, Inc. Date Page J—o <br /> 837 Shaw Road- Stockton, California- 95215-(209)467-1006- Fax(209)467-1118 <br /> P ect T ger <br /> Client Required <br /> Pillone Number <br /> i <br /> ampiers (Signadure) t Invoice, <br /> AGE <br /> Project NameClient ❑ <br /> 1 211� <br /> �i <br /> Sample Type <br /> Sample location Date Time Water Solid No of Nates <br /> Number Description Air Cords <br /> Comp arab <br /> E <br /> e in e y ignature) ece v y p'na;ure Dat°ITimeC <br /> c1 <br /> 17 <br /> Relinquished (Signature) Received by (Signa ure) L)ate/Time <br /> I <br /> Relinquishe by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) OatalTrme Reserve for boratory Date/Time <br /> i <br /> Method of Shipment Laboratory Name <br /> L I <br /> Special instructions `, �) I hereby authorize the performance of the above 1dlcated work <br /> I <br /> i <br />