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• • r 0 <br /> ( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date 11 ZZI Page 1 1 <br /> 837 Shaw Road- Stockton, California- 95215- (209)467-1006- Fax(209)467-1118 <br /> Client ! ! Pro Manager <br /> l L Tests Required <br /> Phone Number <br /> Samplers (Signature) Irwoice- <br /> Protect Name � r , l � � ^ AGE <br /> CI ent� <br /> I ! <br /> Sample Location Na of K <br /> Number Description Date Time Sample Type Water Air Solid Coms Notes <br /> Comp (arab <br /> Eft V ,4- r-A=IA <br /> C--vz)lz� I --T <br /> ,� I I ru <br /> a in i ad re Receivedy ignature e <br /> r <br /> Relinquished by (signature) AecervW-eDdltefTime <br /> ed by (Signature) <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) DatelTima fleceiv,9d fqVL orato by <br /> 71afTime <br /> Method of Shipment Laboratory Name4 <br /> Special Instructions i hereby authorise the performance of the above Indicated work <br /> �� 44 - <br />