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,.� � ..� � wr.. r� ttttttllt� � i_ wi• � � � � � � <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date-6/0y/63 Page `2 of <br /> 837 Shaw Road-Stockton, California- 95215-(209) 467-1006 - Fax (209)467-1118 <br /> Client Project M ger <br /> In)e-/�Q ✓ Tests Required <br /> Phone Number <br /> viz -/chi 6 <br /> Samplers (Signature) Invoice <br /> Project Name <br /> �+'g /cti �! AGE,&` <br /> Client ❑ <br /> Sample Location Sample Type <br /> No of <br /> Date Time <br /> Number Description Water Solid oats Notes <br /> Air C <br /> Comp Grab ! Lab <br /> L aY -ac,j 51 <br /> 3 � � �V0 <br /> A'k-,4�o MLJ6 160-0, JOvu <br /> -41 <br /> zl� <br /> 1 v ►tom ---- IS 0, .� <br /> i is a ignature Received y ignature ate/Tima <br /> v)i(n y (,E <br /> Relinquished by (Signature) Zn4 Rec ed by (S'Gnature) <br /> ((((,,, CPO <br /> Date/Time <br /> C�. O�eh-rnr <br /> Relinquished by (Sign re) Received bo Mobile Laboratory for field analysis (Signature) Datef ime <br /> Dispatched by (Signature) Date/Tims Received for Laboratory by <br /> Date/Time <br /> Method of Shipment Labor Name I <br /> Ldt <br /> Special Instructions I here <br /> b autho ize th p rformanee of the above indicated work <br />