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I• t! t• fi <br /> CHAIN O C�USTODY RECORD <br /> Advanced r� At <br /> 4 Page � of <br /> --� GeoEnviron mental, Inc pate <br /> 837 Shaw Road - Stockton, California 95215 (209)467-1006- Fax (209) 467-1118 <br /> ClientI' E c? In �� Prot Mt1agl, ? 1 s Required <br /> �i Phone Nmber <br /> 6 a� <br /> 'I rs (Signat re) Invoice <br /> Project Name � AGE <br /> N v4 �� r� � <br /> Client ❑ <br /> Sample Location Sand Sample Type No of Notes <br /> Number Description Date Time Water Air Conts <br /> Comp Grab <br /> -17-7 T 10)61el Ida-'V <br /> �t• <br /> lbo o <br /> Ici <br /> GOOD CONDMONR ADM,,r, wPpR)PREATS 1 <br /> bRCHLORINAMD 1N LAB PRSS RVED 1N <br /> V m Oka <br /> e inquM.d <br /> (Si na ur ecerve y igna;ure D e[Time <br /> Relinq l I9nature) Received by (Signature) f Date(Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date(Time <br /> K� <br /> Dispatched by (Signature) Dalefflme Re v I La orator0 Sime <br /> Metho I of Shipment Labar N me <br /> NLC <br /> Speciel Instruclions I hefebaut rite the p tormance of the above Indicated work <br /> i <br /> � <br /> �L' <br />