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• <br /> j Advanced CHAIN OF CUSTOD RECORD <br /> GeoEnvironmental, Inc - Date o �r�l Page / of / <br /> 837 Shaw Road- Stockton, California- 95215- (209)467-1006 Fax (249) 467-1118 <br /> ClientProject Manager <br /> &,rc VA IAJ I Man Tests Required <br /> Phone Number <br /> a0`I - Ll(o - oot <br /> Samplers (Signature) �y Invoice <br /> Prosect Name 11 �� <br /> i AGE.K <br /> G•n e L ey C i T Y"A0j,., Client ❑ <br /> t� LO --- <br /> Sample Location Sample 7ype No of -Z' &, a <br /> Number Description Date Time Water Air Solid Cants ttI f 65900 <br /> Comp Grab <br /> I <br /> r►wt�o�Mi3o� 011130 le4s' /-/ 3< �( �( >( 6590 <br /> i65902 , <br /> ��/Gw+3vt a�li3UK ►��o ,K �J �( )C � <br /> 65903 <br /> I , <br /> %i40-J/0` 60 Cy,l o t V-30 X <br /> V0A 0 M ALS TH <br /> He y ( ' nature) ecewe y ignature Datefrime <br /> ME <br /> VO n H APPROPRIATE /R 091101 / t s yb <br /> R ulshed by (Signature) Received by ( i CONTAINERS V Date/Time <br /> GOOD CONDI ION APPROP IATE <br /> Relinquished by (Signature) d by M teid analysis (Signature) Datefrime <br /> Dispatched by (Signature) Dateffima Received lot Laboratory by DateMme <br /> �"30 <br /> Method of Shipment � � ahoralory Nama��� <br /> Special Instructions 1 I hereb su home the performance of the above Indicated work <br />