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Z Sc HAIN OF CUSTODY RECORD <br /> � Z <br /> �- <br /> Advanced Date c�3' Page _� of <br /> GeoEnvironmental, Inc. d-b--9 <br /> of Northern California 0 <br /> 1803 West March Lane,Suite A-Stockton California-95207 (209)956-0264-Fax(209)956-0700 <br /> Protect Manager Tests Required <br /> Client � t� �C� (,(�� � t � /u �"� <br /> Phone Number <br /> Invoice <br /> Samplers (Signature) <br /> AGE 2/ <br /> `1�d Client ❑ <br /> Protect Name !N <br /> Sample Type No of Notes <br /> Sample Location Date Time Water SolidNo <br /> Number Description comp Grab70 <br /> Ar <br /> O <br /> V, U ✓ <br /> ✓ ( ✓ <br /> ��'t tJ �<<r V ✓ / v e/ <br /> Delp/ tme <br /> e e e + narur l �^ kS C[ im <br /> e+nquis e y ( ignature 1_ 1 l /'T 1 11 <br /> DatelT+me i <br /> i ishe y (Signature) Received by (Sign lure) <br /> Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) <br /> Date/Time <br /> Date/Time Received for Laboratory by <br /> Dispatched by (Signature) <br /> Laboratory Name <br /> Method of Shipment I <br /> I hereby authorize the perform ce of the above Indicated work <br /> Special Instructions <br />