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.�.. �� �■� t»it: rttft>w■ ftfififififlf � � � � � iw � � � <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date�'r ' l�`� Page ( of Li <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 /> Gcc, LAu.,-7 - (C,C'W <br /> Samplers (Signature) <br /> r Invoice <br /> Project Name � C, AGE <br /> Client ❑ <br /> Sample Location Sample Type , <br /> Number Description <br /> Date Time Water Aar Solid C of <br /> N Notes <br /> Comp Gtab <br /> X1 <br /> �J11A,l* �,� �� r� k �t�� � ' kXXA ,vow � <br /> V <br /> V\W 121 X1/1 W 17, "130 X XIX XX <br /> -- <br /> ,mw V�A �AA VV XXX X 1 <br /> K YX X1 I --tow <br /> MVV t��l ,\AW X }C <br /> Rai' she y i ute ecewe y ignalure datelTime <br /> �r <br /> j Relinquished by (Signature) Received by (Signature) <br /> DatefTim <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analy a ( u-nature) i DatefTime 16 <br /> Dispatched by (Signature) DalelTime TMMV <br /> y Date/Ti <br /> w <br /> Method of Shipment Leboratame <br /> CL\, T C� <br /> Special Instructions ` —� � � �t I hereb uthorixe the p of the a indicated work <br />