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f _ Advanced CHAIN OF CUSTODY <br /> RECORD <br /> GeoEnviranmental <br /> , Inc.InCDate 0 to 10" Page at n`3 <br /> 837 Shaw Road -Stockton.Caldarnia- 95215 _(209)467-1006- Fax(205) 487-?118 <br /> Client ` rt Pr eq M per fa~1Q <br /> TOM Regwfed <br /> LD <br /> Phone NN ber <br /> o 1 N <br /> S lens: (Signature <br /> h I <br /> Project Name Invoice: 01.� u <br /> i AGE <br /> Sample , Client co <br /> Location Sample Type <br /> Number Description Date Time Water Solid No. of <br /> Comp, Grab_ Air Cont5, Notes <br /> D <br /> C1i <br /> M <br /> rn <br /> 0 <br /> C) <br /> 0 <br /> z <br /> is e y. r 1c,a <br /> ete 49 y. gna ure qI <br /> Daieff <br /> { <br /> elinqulshed Dy_ (Sigrtatu Received by; (Signature) La-�o <br /> OatsTTtme <br /> elingaiahed by; igrralureJ Received by Mob ife l.aboratnry for Held anwlysts (Signature) <br /> baleJl'ime <br /> Dispatched by—(S—Ig nate/T11me <br /> Racetwd or a ora <br /> Datafn e <br /> Method of Shipment: O_ ^� D <br /> be dory Name` � <br /> Special instructions: m <br /> I it y authorize the perlormance of rhe above lndioated walk. <br /> N <br /> Ln <br />