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i i i ; ! ! ! ! ! ! ! ti triiiiiiiiiiiif lfffff♦ iftifff� f1f1f� iffiffiftf� <br /> VISIONEER <br /> f <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnyironmental, Inc -, ° w- Xate 1110 -U 3 Page __;L of <br /> 837 Shaw Road Stockton, California- 95215 (209)467 1006- Fax (209)467-1118 <br /> Client 1 � t ( � `� Project Manager Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> Project Name t A- AGE ❑ <br /> h r: �A' f +:41 �J Client <br /> Sample Location Sam Ype No of r✓ �� <br /> Number Description Date Time Water Air Solid Conts Notes <br /> Comp Grab <br /> C?T y" VO 3 es <br /> G PT- 4-( 70 <br /> Z�—ed <br /> y ( q eived b Signature) 1JatelTime <br /> cashed by (Signature) ecei714ed (Signature) tlate(Time <br /> I <br /> Relinquished by (Signature) Rece by Mobile Laboratory for field analysis (Signature) Date/Time <br /> i <br /> Dispatched by (Signature) DatefFime Received for Laboratory by Date[Time <br /> I <br /> I <br /> j Method of Shipment Laboratory Name <br /> special Instructions t hereby authorize the performance of the above indicated work <br />