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i • • <br /> { Advanced CHAIN OF CUSTODY RECORD <br /> --= GeoEnvironmental, Inc. Date 5 �� Page Z Z <br /> ' 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> Client Project Manager Tests Required <br /> L <br /> Phone Number <br /> 265' <br /> Sample s (Signature) t" Invoice <br /> b <br /> AGE <br /> Project Name A ClientAX ❑ <br /> Sample Type W <br /> Sample Location pate Time Water Solid No of / rt/ Notes <br /> Number Description comp Grab �1ir Conts <br /> A606 ��- / t � .3 X � 67670 <br /> l <br /> e rnqurs y ( ig Lure) Received By (Signature) Date[Ttme <br /> SLdgw /G60 <br /> Rah ed �gn Received by (Signature) �atefrtme <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) ' ! DatelTime <br /> Dispatched by (Signature) Date/Time AeceiW4 for Laboratoryte/Time <br /> 21�7 Q/ //3U <br /> Method of Shipment Labor ry Name <br /> e-Ac�1/Er�J1I�(, M G- <br /> Special instructions I hereby author the performance of the above indicated work <br />