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i i i i i i ! >• i � i i i i i i i i a <br /> Advanced CHAIN OF CUSTODY RECORD <br /> � <br /> GeoEnvironmental, Inc. Dale 2-;'-0Y ease <br /> 837 Shaw Road -Stockton California- 95215- (209)467-1006- Fax (209) 467-1118 (0 , Q 23 <br /> r <br /> Client -Project Manager Tests Required <br /> Phone Number <br /> Samplers (Signature) �b\ Invoice <br /> AGE , <br /> Project Name f �s i Cherd ❑ <br /> (� Sample Type <br /> Sample Loc ion Date Time Water i Solid No of Notes <br /> Number Description Comp Grab Air Conts <br /> kJ <br /> 6 —oZb <br /> �a-ids 1 XE <br /> me <br /> �5hedby lure ecerve y ignature DalelTtture) Received by (Signature) Daloffirne <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) l Datefrime <br /> Dispatched by (Signature) Datefrime Received for Laboratory by / Date/Time <br /> Method of Shipment Laborato ame fLe <br /> I hereby authorize thaf performance of the above indicated work <br /> Spacial Instructions <br /> a- �- <br />