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i ! • <br /> CHAIN OF CUSTODY RECORD <br /> Ad v me ed <br /> %'- GeoEnvIronmental, Inc aq Z I . Date Page _ ofr <br /> \� 4005 North Wilson Way Stockton California-95205 (209)467 1006 Fax(209)467-1118 <br /> ClientProject Manager Test Re mored <br /> t ern ('r,V- L� r r Mrhu <br /> Phone Number y <br /> Samplers (Signature) Invoice <br /> Project Name � AGE [� <br /> Client ❑ <br /> Sample Location Sample TypeDate Time WatSolid No of <br /> ter � <br /> Number Description Air Conts Notes <br /> Comp Grab <br /> 1 ? 5 �87�7 <br /> >< 1 x' 778 <br /> e inqut d by (Signet re) Receivedy (Signature) _ Date/Time <br /> Relinquished by (Sig ature) Received by (Signature) Date/Time <br /> Relinquished by (Signature.) Received by Mobile Laboratory for field analysts (Signature) Date/Time <br /> Dispatched by (Signature) DatelTime Received for LaSoratory DatelTime <br /> G �— <br /> Method of Shipman J— WWILabor ry k me { / J <br /> Special Instructions �+ l „r b authorize the performan a of the above indicated work <br /> 6�OJ CUh?IT?�!Y n rt U/t1t <br /> CEWfT <br />