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j Advanced CHAIN OF CUSTODY RECORD <br /> "- Date 1 0-Lo- s Page of <br /> GeoEnvironmental, Inc. �/03� <br /> 837 Shaw Road-Stockton, California 95215 (209) 467-1006- fax (209) 467-1118 <br /> Client � ��� r f�t� Project Manager <br /> — -•-• 19lu- , > Tests Required <br /> tku Phone Number <br /> Samplers (Signature) A Invoice <br /> Protect Name 14)db <br /> � AGE <br /> ��/o/z, L� (r� Client ❑ <br /> Sample Location Sample Type No of <br /> Water <br /> Number Description Date TimeSolid t Notes <br /> Comp Grab Air Coats <br /> W W114 [W <br /> ICU C'NTI <br /> �:ti � <br /> D4C' QrWX' F.D IN L&J P IN <br /> e ulquloed by I re) ece ve y (Signature) <br /> Datefrime <br /> Rehnqu shed by (Signature) Received by (Signature) <br /> Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> t <br /> Dispatched by (Signature) Date/Time ARelyfor Laboratory �n/ Q elTlme <br /> Method of Shipment ? !7f7lLhereby <br /> rato me TTZZ �� <br /> CVGW - T( C ,, ) <br /> Special instructions i' r authorize he performance of the above Indicated work <br /> a4i� L <br />