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[ [ f I t I I [ t [ t iC [ [ t I t I [ <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. 0�O7�3 q Date '7 o- - Page '� Of <br /> 837 Shaw Road - Stockton, California - 9521.5 - (209) 467-1006- Fax {209) 467-111 B <br /> ClientQ Project Mana er <br /> AI Tests Required <br /> Phone Number <br /> amplers: (Signature Invoice: <br /> Project Name AGE��� Client ❑ <br /> Sample Location Sample Type <br /> NO <br /> Date Time Water Solid °f <br /> Number Description Notes <br /> comp. Grab, Air Cants. <br /> co f <br /> /17 -70 <br /> t'e...f AFS <br /> =77.',. .. ... .. <br /> We inqu st e � Ignature Receive y: Ignature D telTime <br /> Relinqu shed b : (Signature) Received by: (Signature) Date/Tlme <br /> Refinqulsited by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: JSignature) Date/Time Received for Laboratory by: Date/Time <br /> hltethod of Shipment: Laboratory Nagre / <br /> Special Instructions; i hereby auth the pe formance of the above Indicated work. <br /> I <br />