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• i i <br /> ( L Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvirolnmental, Inc. Date2l Page .3 of <br /> 4005 North Wilson Way-Stockton,California-95205 (209)467 1006 Fax(209)467-1118 <br /> ClientV �� ,S Project ManAIV JDFC (!7. <br /> J Tests Required <br /> Phone Number <br /> G - V 10P .�f <br /> Samplers (Signature) �� Invoice <br /> Project Name AG <br /> C L. �� 5Client ❑ <br /> Sample Location Sam/Ie-,(Type <br /> Date Time Solid No of <br /> Water <br /> Number Description Air Conts -'� Notes <br /> Comp Grab <br /> 1 011 5OPiAo) Mu <br /> tv. Cal <br />/tet ' 7A t <br /> 55 <br /> ems' ± a y (.Qig I Received by ignature S 719 <br /> fU00A� Date/Time <br /> Relinquished by (signature) - Received by (Signature) r! Date/ infe <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (signature) Date rime <br /> Dispatched by (Signature) Date/Time terve orLaborat ry by Datefrime <br /> _/ <br /> Method of Shipment Laboratory Name <br /> _ CA { <br /> Special Instructions I hereby authorize the performance of the above Indicated work <br /> XJ <br /> ;Y7 <br />