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.� ttttttttttt� tttttttttn■ tttttttttt� ttittittitlf t■I■■ 4Fi• Ittttttttttt# 4"' "' <br /> Il�l/1 <br /> L <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date EM 2- r, Page i of <br /> of Northern California <br /> 1803 West March Lane Suite A Stockton California 95207 (209)956-0264-Fax(209)956-0700 <br /> ClientProject Manager <br /> C �,e Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> Project Name AGE <br /> A 40. 95 -0 ' Client <br /> Sample Location Sample Type <br /> Date Time Water Solid No of Notes <br /> Number Description comp Grab Air Conts <br /> qb <br /> r <br /> N�uJ IA CtW f I •ti U X <br /> X - 3 <br /> Rel qws e y (Sign ture) 'Received y ignature <br /> f7atelTime <br /> Z C4 <br /> Relinquished by (Signature) Rece ve b i — a O f� <br /> ate/Time <br /> IL �9 <br /> Relinquisheda- A✓ <br /> Relinquished by (Signature) Receive by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) DatelTime Received for Laboratory by Date(Time <br /> Method of Shipment Laboratory Name <br /> C-' h <br /> Special Instructions I hereby authorize the performance of the above indicated work <br />