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� � � � I• � � � � � � � � �! ��� fi11111ilililll <br /> CHAIN OF CUSTOD RECORD <br /> Advanced Date - �� Page —z_of �Z- <br /> --- ;'R GeoEnvironmental, Inc. <br /> 837 Shaw Road-Stockton, California-95215-(209)467 1006- Fax(209) 467-1118 <br /> Client ProjMana r 9� V-1 C ITests Required <br /> Ph Number <br /> Sam (St nature) Invoice <br /> AA ot�' I <br /> AGI; <br /> Project Name Client ❑ <br /> Sample Type <br /> Sample Location Date Time Water Soltd No of Notes <br /> Number Description Comp Grab Air Conts <br /> a2 <br /> Or <br /> 1 -.�. <br /> Pein re starve y ignatura te/Tim <br /> e inqUedi s ) <br /> z <br /> Relinquished by (Signature) Received by (Signature) /Dateflime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatelTime <br /> Dispatched by (Signature) Date/Time Received for Laboratory by Date(Time <br /> Method of Shipment Laboratory Name <br /> Special Instructions <br /> t � I hereby auth ze the peri mance of the above indicated work <br />