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�� tt� tttttttttt� srt� ttft>• tfffffff� f� � � � � � � � <br /> ( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmentai, Inc. Date -7116A41 Page of <br /> 837 Shaw Road- Stockton, California- 95215- (209)467-1006-Fax (209)467-1118 <br /> Client Pro ect Manager <br /> I( L44 <br /> Tests Required <br /> Shone Nkimber <br /> Samplers (Signature) Invoice <br /> Project Name a AGE <br /> Client ❑ <br /> Sample Location Date Time Sample Type No of O/ <br /> Number Description Water Air Solid Conts Notes <br /> Comp Grab <br /> Relinquished y ign re eceive y ignature <br /> 0alG71me <br /> +? 6 d <br /> Rehnqu shed by (signature) Received by (Signature) <br /> Uatel rime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Datelt ime <br /> Dispatched by (Signature) DalelTime Received for Labors by ) �} Gateffime <br /> Method of Shipment Laboratory Name <br /> (Sc, 17 <br /> b U� K � C <br /> // <br /> Special Instructionst �/ I hereby authorize the performance of the above indicated work <br /> 46 F <br /> It k t Ilease ! <br />