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•Advanced CHAIN OF CUSTOD ECORD <br /> GeoEnvironmental, Inc. <br /> Date �2_ Page —Z- of <br /> 4005 North Wilson Way-Stockton,California 95205-(209)4674006-Fax(209)467-1118 <br /> Client [7 Protect Mana er <br /> woorL� Tests Required <br /> Ph ne Number <br /> I � <br /> Samplers (Signature) Invoice <br /> Protect Name // // AGE <br /> J <br /> i( W Client ❑ <br /> Sample Location Date Time Sample a r Type Solid No of �/ Notes <br /> m <br /> Number Description Air Conts <br /> Comp Grab <br /> U�. <br /> f 6 I <br /> x <br /> Btq-35' � r <br /> j 892 1 <br /> qc) <br /> qt <br /> e mqurs a <br /> Y. ignalute Received '' alerfime <br /> y i store k� �►� 4K <br /> Reiinq fished by (Signa ore)`—' Received b ignalure) �y::orf`caterrime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Daterfime <br /> Dispatched by (signature) Date/Time Received for Laboratory by DaletTime <br /> Method of shipment Laboratory Name <br /> C/4- (� �} t hereby authorize the perlor ante of t e above indicated work <br /> Special Instructions `il/ell U4YL1 Ir�LTLS ��i lE <br /> WOOP' 4� F I �Ti�,i <br /> I� r 3�1 L�ulvrrl! t��i���'<<4LIIJ <br />