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• CHAIN OF CUSTODY RECORD <br /> Advanced Date 1Z Z-3'�1�Page e of <br /> -�-�- GeoEnvironmental, Inc <br /> of Northern Calrforniu <br /> 1803 West March Lane Suite A-Stockton California-95207-(209)956-0264 Fax(209)956-0700 <br /> i Protect Manager Tests Required <br /> Client PL P Y 1 _ � L ST�i7 11("- <br /> Phone <br /> G/Phone Number <br /> Samplers (Signature) Invoice <br /> AGE <br /> Project Name � � � �� <br /> Client L <br /> Sample Type No of <br /> Sample Location Date Time Water Solid Notes <br /> Number Description Comp Grab Air Conts <br /> 2CO <br /> f Ir <br /> C r' 1?� �0 <br /> 9DatelT+me T <br /> e+n e y (Signature Received by (Signature) -Z^ r <br /> r—� Dal©!Time <br /> Relinquished by (Signature) Received by (Signature) <br /> Date/Time <br /> Relinquished ay (Signature) Received by Mobile Laboratory for field analysis (Signature) <br /> Date/lime Rcc rvp< t Labor l ty b / Dal [Time <br /> Dispatched by (Signature) � � r v <br /> Lab o story Name ACV,Metho of Shipment <br /> r I hereby authorize the porlormance of the above indicated work <br /> Special Instructions <br /> C + �r <br /> �- <br />