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0 <br /> ( Advanced CHAIN OF CUSTODY RECORD <br /> - = GeoEnvuonmental, Inc. 2 ° e z Page --(—of - <br /> 837 Shaw Road - Stockton, California- 95215- (209)467-1006 - Fax (209)467-1118 <br /> Client Pro ect M nanar <br /> � Tests Required <br /> Phone Number <br /> .ti <br /> Samplers (Signature) Invoice <br /> Name Project Nam AGE ❑ <br /> � � � ❑ <br /> Sample Tape Client� <br /> Sample Location pTime No Of <br /> Date Number Description Water Air Solid CoNotes <br /> rits 1/ <br /> Comp Grab <br /> q 3- s <br /> was 131 <br /> d3C <br /> elinqui y Aihna re Received by rgnat o telTime <br /> :�7 15 1,76t) <br /> Reimq fished y (Sigature)L _ r Y Received b (Sr nature) --- Date/Time <br /> tipNt B om <br /> Relinquished byry <br /> carrfnN cey i o e Laboratory for field analysis (Signature) Data Time <br /> on Atm <br /> I-,AD SPACE APSr-NT CDNTAINE <br /> Dispatched by ( rg ature)- Ku 74 �ate/Time Rec r e for Laborato TIme � <br /> Method of Shipment aborato K me 3 <br /> . I <br /> cSp�eciaPl tntruc s �JAIP� <br /> 01 r hereby <br /> rmance of the above Indicated work <br /> r <br />