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E02) ?m- o77 <br /> Advanced CHAIN F CUSTOD RECORD <br /> � � <br /> Date Page of <br /> --- GeoEnvironmental, Inc. <br /> 837 Shaw Road- Stockton, California-95215 - (209)467-1006- Fax(209)467-1118 <br /> Client Project Manager Tests Required <br /> Phone Number <br /> 57 <br /> y 0 J� 40 6 0 o Sa pl s fgnatur Invoice <br /> AGE �— <br /> Project Name IKL Client ❑ <br /> 10.74"' <br /> Sample Location Sample Type Sold No of Notes <br /> Number Description Date Time ComWater Air Conts <br /> �a2 D <br /> ecetve (signature) atelTrme <br /> a'in u e tgnatur Y <br /> Rel, gwshe by ( ignatu* Received by (Signature) pate�Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> �1 <br /> Dispatched by (Signature) Date/Time Received for Laboratory by Date(Time <br /> Labors Name <br /> Method of Shipment �k (—IeAri� <br /> Special Instructions I hereby authorize t erformanos of the above Indicated work <br />