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• 0 - <br /> � Advanced , <br /> CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental Inc. Date��L3L} Page of <br /> 837 Shaw Road-Stockton, California- 95295- (209)467-1006- Fax (209j)467-1118 <br /> ClientGid N Project a ager / Tests Required <br /> 16,Phone Number <br /> 1606 <br /> Sam ers (Signaturef, / Invoice <br /> Project Name / Client ❑ <br /> Sample Location Sam a Type No of <br /> Number Description Date Time Water Air Solid Conts � Notes <br /> Camp Grab <br /> 12 q,J <br /> z.1 0 <br /> T1 11 r14- <br /> t AA.W S D t ` <br /> I <br /> e s e y Lure Received by ignalufe Date rime <br /> 3 ZY <br /> fished by (Signature) Received by (Signature) DatelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> I <br /> I <br /> Dispatched by (Signature) Datefr+me Received for aboratory by 1 Date/Time <br /> Method of Shipment abo► y m <br /> Special Instructions L �� I hereby authorize the performance of the above indicated work <br />