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CHAIN OF CUSTODY RECORD <br /> � Advanced Date l u;�1-c7 3 Page -3 of <br /> - GeoEnvironmental, Inc. <br /> 837 Shaw Road- Stockton, California- 95215- (209)467 1006- Fax (209)467-1118 <br /> GalantProtect Manager <br /> D e r r C 44+f- Tests Required <br /> --- - y 7,r hue.11 CA r <br /> Phone Number <br /> 0,0'q - `1U 7- 100U <br /> ;K.XA9;� <br /> ignature) ,� Invoice <br /> a4 +� <br /> Protect Name ii0 -A. AGE <br /> Client ❑ <br /> PG C. � t �ar {J a S ri <br /> Sample Location Sa yip Na of rX L x <br /> Number Description Date Time Water Air Solid Conts �� Nates <br /> Comp Grab <br /> im <br /> (az�Li2 - 155 <br /> V40-9 <br /> MW-144.5, <br /> -iu-100 <br /> Reoqy.Whedy ( gnatureReceived y ignature Date[T+me <br /> nquished by (Signature) Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for held analysis (Signature) Date/Time <br /> Dispatched by (Signature) DalefrimeRa wal for Laboratory by Date/Time <br />� Method of Shipment L oratory Name C <br /> Special Instructions I hereby authorize the performance of the above Indicated work <br />