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L <br /> Advanced CHAIN qF CUSTODY RECORD <br /> GeoEnvironmental, Inc. die Paye <br /> 837 Shaw Road - Stockton, California-95215 - (209)467-1006 - Fax (209)467-111a <br /> ClientV� t6dk Project Mager <br /> Tests Required <br /> � <br /> one Number � <br /> l©0 ( 4 <br /> Sam rs (Si azure) Invoice <br /> Project Nam AGE <br /> ,C�.a <br /> S4-ex Client <br /> Sample Type <br /> Sample Location Date Time Solid No of Notes <br /> Number Description Water Air Conts <br /> Comp Grab <br /> D/10,63 d0h3 <br /> l �lo�aif <br /> l�eJ b -./40 /Coo <br /> w 611-1D- ' 3 <br /> 0/160.-0 r�� c <br />' <br /> A107 or'r/a-o-7 <br /> e inquts nature eceive y (Signature) ata/Time <br /> ra <br /> Relinquished by (Signature) Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysts (Signature) Date/Time <br /> DateMme Received for Laborator <br /> Dispatched by (Signature) � DatelTime <br /> Method of Shipment aboral NaT <br /> Special Instructions i hereby au ize the formance of the above Indicated work <br /> I <br />