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ti �■■ � f• f• ff� f• � � f• � f� #ll� � � � � � <br /> CHAIN OF CUSTOAECORD <br /> � Advanced Dace Ce��-b`2 Page �_,- of � <br /> GeoEnvironmental, Inc. <br /> 837 Shaw Road- Stockton, California-95215-(249)467-1006- Fax(209)467-1118 <br /> Client ��-�- Lem Project Manager <br /> Vt� Tests Required <br /> Phone Number <br /> (- 40 <br /> Samplers (Signature) Invoice <br /> 1 G� ' <br /> Project Name �at � ,'� �r � •�"`""� `,� ,�� Client ❑ <br /> y <br /> 1, <br /> Sample Type <br /> Sample Location DSolid No of Notes <br /> Date Time Water <br /> Number Description Air Corns d <br /> Camp Grab <br /> &WG--qo wvi -C-S CCko` �-(o-a u-Y5 X i 1 <br /> Relinquished y ( ignature) a y Tgi—gn—atur-eF DatefTrm <br /> Relinqu ed by (signature) Received by (Signature) DatefT me <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) 7- T DatefTime <br /> T, <br /> Dispatched by (Signature) DatefTime Received for Laboratory by DatefTime c� <br /> Method of Shipment Laboratory Name <br /> � � ��tt� C a-L✓ ��� <br /> Special Instructions I hereby authorize the performance of the above indicated work <br />