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i <br /> Advanced CHAIN OF CUSTODYECORD <br /> ( <br /> �11'kZ page l of <br /> GeoEnv><ronmental, Inc Date 1 <br /> 837 Shaw Road - Stockton, California-95215 - (209)467-1006 - Fax (209)467-1118 —O 5 <br /> Client F U �r'� GU �-� pro�e�l Manager Tests Required <br /> Phone Number <br /> Samplers (Signature) Irnotce <br /> _ j ` AGE <br /> Protect Name r��� l fu[j'� Client ❑ <br /> Sample Location Date Time Sample Type Water solid No of Notes <br /> Number Description Comp Grab Air Conts <br /> -shedby ( ignatur Received by (SignatureDate(Time <br /> Relinquished by (Signature) Received by (Signature) DatelTrme <br /> Reiinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Dateffime <br /> Dispatched by (Signature) Date/Trme Received for Laboratory by Data Time <br /> r <br /> Method of Shipment Lab ratory Name./, <br /> I <br /> Special Instructions I hereby authorize the performance of the above indicated work <br />