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' CHAIN OF CUSTODY ECORD <br /> ( <br /> Advanced -1- --7 <br /> --�%' GeoEnvironmental, Inc Dace -7 <br /> Page . (r of—� <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467 1006-Fax(209)467 1118 <br /> Client Tr Protect Manager I/ Tests equ+red <br /> � <br /> Phone Number t <br /> Samplers (Signature) Invoice <br /> �� r;#47Z �/ AGEA <br /> ��Protect Name ., � � '� � Client ❑ <br /> Sample Type No of � <br /> Sample Location Date Time Water Solid Notes <br /> Number Description Comp Grab Air Cants <br /> 12-17 <br /> eceive i nature Datemme <br /> e rnqui_s e y (Sign ure) Y 9 � C;� 12-12-17 <br /> Relinquished <br /> el inq/ r <br /> Daterrime <br /> Relinquished by (Signature) f Received by (Signature) <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DalelTime <br /> Date/Sime Receive oL story by <br /> D te1Ti e <br /> Dispatched by (Signature) <br /> Laboratory Name / <br /> Method of Shipment fl I <br /> CR OVA N t <br /> I authorize the performance of the above indicated work � <br /> Special Instructions <br /> �p ZArYl <br /> Ns G 2e r r <br /> M� � <br />