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1• lfa � f✓• � � � f, f• f• � i• f� i� ii• � f� � <br /> Advanced CHAIN OF CUSTODY RECORD <br /> Date � 2 Page —of <br /> GeoEnvironmental, Inc <br /> 837 Shaw Road- Stockton California 95215- (209)467-1006- Fax(209)467-1118 p f C <br /> Client C C_-710w`-) o ect Manag r Tests Required <br /> one Nu r <br /> 47 <br /> Sam ers (Sign a Invoice <br /> � AGE <br /> Project Name 0 Client ❑ <br /> Sample Location Date Time Sample Type Solid No of Notes <br /> at <br /> Number Description WerComp Grab Air Conts t <br /> I <br /> I , <br /> e nM,5heece+ve y ignatura Onto/Time <br /> r � <br /> Relinquished by (Signature) Received by (Signature) Datef ime <br /> Relinquished by (Signature) Received by Mobil*Laboratory for field analysis (Signature) Datef ime <br /> I E— I <br /> Dispatched by (Signature) Date/Time Received for laboratory by Dato/Ti a <br /> Method of Shipment Lab ory Name <br /> rak <br /> Special Instructions I he uthorize the performance of the ove indicated work <br /> 11\v1 <br /> I <br />