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l <br /> Advanced CHAIN OF CUSTODY REC R <br /> GeoEnvironmental, Inc. pate �8'0� page <br /> 837 Shaw Road - Stockton, California- 95215- (209)467-1006 - Fax (209) 467-1118 <br /> Client � e Fej'r Z PrrckTIJ <br /> ed Manager Tests Required <br /> K4 <br /> Phone Number <br /> %7 —16oG <br /> Samplers (Signature) Invoice <br /> Project Name i SCQ <br /> Client <br /> Sample Location <br /> Sample Type <br /> No of <br /> Number Description Date Time Water Air Solid Conts Notes <br /> Comp Grab <br /> AAA 9-s=d3 ® <br /> I <br /> I <br /> -Relinquished y ture) Received by (signature) Daterrime <br /> Reli qutshed by (Signature) Received by (Signature) DatelTime <br /> I <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysts (Signature) DatelTime <br /> Dispatched by (Signature) DatelTime Received for Laboratory 1 <br /> y DatelTime <br /> Method of Shipment La r ry N e <br /> C <br /> Special tt►sttucttans _ \� ,� 1 hereby uthorize the performance of the above indicated work <br />