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ttftftftftfi i i i i 'tti i i101111111111 i i i i i i mob <br /> Advanced CHAIN OF CUSTODY RECORD <br /> Date 2 Page - of <br /> - - GeoEnvironmental Inc. <br /> ---fir--- `, <br /> 4005 North Wilson Way Stockton,California-95205 (209)467-1006 Fax(209)467 1118 <br /> j Client r E�- is, TA v Lr, t`/2a Protect Manager Tests Required <br /> Phone Number -L7 <br /> Samplers (Signature) } Invoice <br /> Protect Name 1 , AGE <br /> itIV_ r <br /> Client ❑ <br /> Sample Location Sample Type No of ~ <br /> Number Description Date Time Water Air Solid Conts / Notes <br /> Comp Grab <br /> N X X <br /> 54APL -- <br /> t <br /> 'XX <br /> e inquis ed by Received by (Signature-) 20te/Time <br /> STA AJ <br /> Relinquished by (Signature) Received by (Signature) Dale/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for held analysis (Signature) DatelTrme <br /> Dispatched by (Signature) Date/Time Receive ib borai y by D telTrme <br /> Method of ShipmentLaboratory Name <br /> U ti —I SI <br /> Special Instructions I hereby authorize the performance of the above indicated work <br /> Q4 LL t� whin Sim !�� TO �� —Z11 <br />