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■.ssise �sr .sisw esi..ss wsaar was »a*se s� s�s� .sem ssssrrer sir ..... si..s� s� �■ �. <br /> 1 ` ( Advanced PA CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date 2— Page of <br /> 837 Shaw Road -Stockton, California- 95215 (203)467-1006 Fax (209) 467-1118 <br /> Client Project Manager Tests Required <br /> 131LL/— L4 <br /> Phone Number <br /> Samplers (Signature) rL Invoice <br /> Project Name _ <br /> 4Z� <br /> - AGE <br /> Client ❑ <br /> Sample Location Sample TypeDateTlme No of ' <br /> Number Description Water Air Solid Conts Nates <br /> Comp arab <br /> T '� <br /> My a ♦ y <br /> Relinquished y i nature Received by (Signature) <br /> Relinquished by (Signature) Received by (Signature) �� f h/l �J 1 <br /> UalelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Daleffime <br /> Dispatched by (Signature) DatelT rna s ve�d,for aboratary by Dateffirne <br /> Method of Shipment <br /> � Laboratory Name <br /> Special InstructionsF A4)- L2 <br /> I hereby authorize the performance of the above Indicated work <br />