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� i• � r � ■tom � +, � � � � � � � � � ti• ti• r• <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date Page of <br /> 837 Shaw Road-Stockton,California-95215 - (209)467-1006- Fax(209)467-1118 <br /> Client Project Manager <br /> Tests Required <br /> Phone Number <br /> ��? la GI& <br /> Samplers (Signature) Invoice <br /> Project Name P00C [ tic- lk)("" <br /> AGEf S r� a Client p <br /> Sample Type <br /> Sample LocationSample <br /> Time � '' <br /> Number Description Water Air Solid Counts �` x Nates <br /> Comp Grab <br /> j <br /> Jew Z,kc r-3r LJ <br /> f"W3 43 k:,3 1139 <br /> C L-7 <br /> P Ica <br /> Re i is e y nature Receivedy (Signature) <br /> DatalTtma <br /> Relinquished by (Signature) / Received by (Signature) Qateto <br /> lTime <br /> Relinquished by (Signature) Received by (Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) DatelTime Received for Labgtptory Ay Date/TI <br /> (Method of Shipment L ato N <br /> Special Instructions I hera Authorize the pertarmance of th above indicated work <br />