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■� ■� ill• !� �!• � � � � � � i• � � � � � � � <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date 12 Z16 5( Page _12L of <br /> 837 Shaw Road-Stockton, California-95215- (208)467-1006 - Fax (209)467-1118 [� <br /> Client r Pro ect na er Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> Project Name �0� AGE <br /> Arc6 ly. Client x ❑ <br /> Sample Location ample Type , <br /> Date Ttme Water Solid No of Notes <br /> Number Description <br /> Comp Grab Air Conts <br /> g it Et IL130 <br /> KWILA I?,Lik it <br /> a in i e y gnature Received by (Signature) Date/Time <br /> 2S 0 <br /> Relinquished by (Signature) Received by (Signature) DatelTrme <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatefTime <br /> Dispatched by (Signature) Date/Time Received for Laboratory by Date/Time <br /> Method of Shipment La bar ory me <br /> Special Instructions pp � �A r 1� A I hereb uthonxe the performance of the above indicated work <br /> f� <br />