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I • t <br /> Advanced CHAIN OF CUSTODY RECORD' <br /> GeoEnvironmental, Inc. <br /> Date JD? Page a'of <br /> 837 Shaw Road-Stockton, California-95215- (209) 467 1006- Fax (209)467-1118 i p � 3 <br /> Client C • o ect Manag r <br /> �'� Tests Required <br /> hone Nu r <br /> Sam ers (Sign a Invoice <br /> Project Name <br /> AGE <br /> Client ❑ <br /> Sample <br /> Sample Location ype No of <br /> Camp Grab ' <br /> Number Description Date Time Water Air Solid Conts p N Notes <br /> a eceive y ignaturo DatelTrmenqis <br /> Relinquished by (Signature) Received by (Signature) DalelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatefTrme <br /> Dispatched by (Signature) Datefrime Rocervod for Laboratory by Date/Tr e <br /> a z .a 4 <br /> Method of Shipment Labo ory rakName- <br /> /41 <br /> v / =__e� <br /> Special Instructions I M ""� t I hereb uthorize the performance of the ova Indicated work <br />