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j Advanced CHAIN OF CUSTODY RECORDof <br /> �� <br /> _ = • <br /> -�:: <br /> GeoEnvironmental, Inc. Date Page <br /> 837 Shaw Road Stockton, California- 95215 - (209) 467-1006 - Fax (209)467-1118 <br /> Client }-,' 11 Project Manager <br /> In M Tests Required <br /> Phone Number <br /> Samplers: (Signature) tt `` ; " Invoice: <br /> Project Name i /(.� t? --� �_. AGE (] <br /> Client <br /> Sample Type <br /> Sample Location Date Time Water Solid No. of �` .'�^" ��* Notes <br /> Number Description Comp. Grab. Air Conts. <br /> elinquis a y: ( i rt u / Receivedy: ignature Date/Time <br /> - <br /> Relinquished by: '(Signature) Received by: (Signature) Date rime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Date/Time <br /> Method of Shipment: Laboratory Name <br /> Special Instructions: I hereby authorize the performance of the above indicated work. <br /> IJ0, / /'i.'L L?\I L 1 <br /> J <br />