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CHAIN OF CUSTODY RECORD <br /> � Advanced Date &�Iq�� �` of <br /> `GeoEnvironmenta�, Inc. page <br /> 837 Shaw Road Stockton, California- 95215 - (209)467-1006- Fax (209) 467-1118 U b � 7 <br /> Clientprole Man ger <br /> Tests Required <br /> one Numbell: <br /> Sam lers (Si ature) Invoice <br /> Protect Name ( AGi= <br /> i - Clfe ❑ <br /> Sample Type <br /> Sample Location Date Time Water Solid No at Notes <br /> Comp Grab <br /> Number Description Air Conts <br /> ,kuICa_� It <br /> riFfyisheany 11 gnat Received by (Signature) Date/Tr e <br /> R urshed by (SigWalbreT Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) < <br /> Date/Time <br /> Dispatched by (Signature) Date/Time Received for Laboratory by oat IT <br /> 1 -o o <br /> Method of Shipment Labors Name <br /> Co C�1.���' <br /> Special Instructions LA I hereby authorize the erformance of the above indicated work <br />