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i 0 o-7 -138 0 - <br /> ( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc, Date Page of <br /> 837 Shaw Road- Stockton,California-95215- (209)467-1006- Fax (209)467-1118 <br /> ClientPal t t Protect Manager Tests Required <br /> Phone Number <br /> k34 it <br /> Samplers (Signature) 1 Invoice <br /> 1� AGE <br /> Protect Name 1 � �� ! f Client ❑ <br /> Sample Location Sample Type <br /> No °} <br /> Date Time Water Solid Notes <br /> Number Description Comp Grab Air Co <br /> r1tS <br /> Qg4U ✓ <br /> V/ x <br /> ✓ 2 ?� <br /> eelinggis e y i nat re „ ace vs y Ignature Dats/Time <br /> 6 t <br /> Relinquished by (Signature) Received by (Signature) f�r � C Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Received for Laboratory by Date[Time <br /> 3 <br /> Method of Shipment L oratory Name <br /> O Tei6 tft� <br /> Special Instr tions I hereby authorize the performance of the above Indicated work <br />