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ttttttttt� fffffffff� 11=1 M <br /> CHAIN OF CUSTODY WORD <br /> Advanced <br /> Date _ �� Page —�— of <br /> GeoEnvirorimental, Inc <br /> 4005 North Wilson Way Stockton California 95205 (209)467 1006 Fax(209)467 1118 <br /> ClientV u y) P� '� c Tests Required <br /> Project Manager 1 l��c <br /> Cv ! ra, � r <br /> Phone Number <br /> 7— �I.'n <br /> 0 Lam~ <br /> Samplers (Signature) Invoice <br /> AGEK <br /> Project Name C a � t " �� Client ❑ <br /> Sample Type <br /> Sample Location Date Time Water Solid No of �� � Notes <br /> Number Description Air Conts <br /> Comp Grab <br /> �y <br /> 711-17 t8 <br /> e quis e y (Sign tura� Received y (SignatureDate/Time <br /> m <br /> Relinquished by (Signature) Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date[Time <br /> Dispatched by (Signature) Date/Time Re ce eye r Labor y y/ Date/Time <br /> Method of Shipment Labofalory Name <br /> Special Instructions It hereby authorize the performance of the above indicated work <br /> I <br />