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� � � I• � � � � � � r 1• � � � � ffflfffffffffff fffffffff� <br /> Advanced <br /> CHAIN OF CUSTODRECORD <br /> t j <br /> �Z+ ��~ <br /> --- ;'- GeoEnvironmental, Inc Date Page / of <br /> 837 Shaw Road - Stockton, California- 95215- (209)467-1006- Fax(208) 467-1116 <br /> Client rt— c 1 Pro !t-(— L��1'�' . <br /> w � •—� �,� er Tests Required <br /> Phone Number <br /> Samplers (Signature) / Invoice <br /> AGE <br /> Project Name 4 1 V-2> j J }�� Client ❑ <br /> Sample Type <br /> Sample Location Date Time Water Solid No of Notes <br /> Number Description Comp Grab Air Conts <br /> 12.i$- 2-1 X <br /> e in.wIs y ignature Receivedy (Signature) Date ime <br /> 1 a <br /> Relinqwshe by (Signature) Received by (Signature) f�� /, � f Date/Iime <br /> Relinquished by (Signature) Received by Mobile Laboratory for held analysis (Signature) ( �+ Date[Time <br /> Dispatched by (Signature) <br /> DaterTime Received far L or t ry by j , D avf ime <br /> IN <br /> Method of Shipment La oratory Name <br /> 1 Te-cT <br /> Special Instructions l hereby authorize the performance of the above Indicated work <br />