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� tri• � � � I• � � � s• � � � � t� !, � � � <br /> Advanced �{ r CHAIN qF CUSTODY RECORD <br /> GeoEnvironmental, Inc. <br /> Date �d �f Page O <br /> 837 Shaw Road- Stockton, California- 95215 - (209)467 1006- Fax(209)467-1118 <br /> Client f r �; Project Manager Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> Prolec,t Name ? 'V � a ��� _ _ '.�- , AGE <br /> .- S c Client ❑ <br /> � <br /> Sample Location Date Time Sample Type No of Notes <br /> Number Description Water Air Solid Cants <br /> Camp Grab <br /> 14 13 3 <br /> J <br /> -11e1.1apute�y k re stave y (Signature) elTkme <br /> Relrnqur hail by (signature)- (Signature) _gnaturej- Received b Si s� � <br /> Date(Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) 17ate/Tlme <br /> I A r <br /> ({ <br /> Dispatched by (Signature) DatelTime Received for Laboraloly - --- D a1TVme <br /> Method of Shipment La oratory Na <br /> Spac�a�gq�, 1 heresy_authorize ps periormance of the above indicated work <br /> 4300D WNDM At PRTA1 s REUD SEALED & INTACT VIAMEAD SUCH ASQMW-�� <br /> AFCt[L+ORIidA1EU IN LAi#__r„__P=sEKVED IN ) <br /> vo�s tics �� 17t�R <br />