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� tttitti � t� t_ i � i i ttti fli i i• � i i i >, � <br /> i Advanced CHAIN OF CUSTOD RECORD <br /> GeoEnvironmental, Inc. Date Zi i ` Page —� of <br /> 837 Shaw Road-Stockton, California- 95215-(249)467-1006 Fax (209)467-1118 n �f �` <br /> Client B.0b G� Protect Manager Tests Required <br /> Phone Numb& <br /> Samplers (Signature) �� Invoice, <br /> Project Name 1 ��q �� 4 �, �o AGE <br /> Chem ❑ <br /> Sample Location Sample Type , <br /> Number Description Date Time Comp crrsb put Solid Conts �q�X ^ ` f Notes <br /> RW 175- <br /> i Wc...i -7-"D it <br /> Ll to <br /> KW b —5 Jit VV <br /> P-UJ fe, - It t' ID 1 Y, Y, x X <br /> W\A,-,, �- 15f <br /> KWio-2D 133 <br /> Relinquished y ( ignature Received y (Signature) Data/Tim <br /> Rehri4utiihed by (Signature) Received by (Signature) baterdme <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Dale/Time Received for Laborato y DatelTime <br /> Method of Shipment Ld6oratory Name <br /> "A - 'fl vmw ic,kms` CA-L- Tezo <br /> special Instruction I hereby authorize the performance of the above indicated work <br />