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' s � <br /> ( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date Y462� Page - of-f---- <br /> 837 Shaw Road-Stockton,California-95215-(209)467-1006 - Fax(208) 467-1118 Oma{ _ �1 <br /> Client j l Project Man 17Project 1 <br /> r� �tii ��' !� �� �t Tests Required <br /> Phone Number <br /> bit) <br /> Sample s (Signature) {rrnoice <br />� f <br /> Project Name 00X AGE J <br /> Client <br /> t1jAJ <br /> �� ('a� Client <br /> Sample Location Sa yle No of ' <br /> Number Description Date Time Water Air Solid Ct7rlts Notes <br /> Comp Grab <br /> M�tzk tel V Zile <br /> e us e y ature eceive y Mgnature DatelTime <br /> If6strn'quished by (Signature) Received by (Signature) DatelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date(Time <br /> Dispatched by (Signature) DatelTime Received for Laboratory by Date/Time <br /> 1 <br /> Method of Shipment Ile Lab ory m / �, <br /> L.1eve.rA./1lee I <br /> Special Instructions i� /� I hereby thorize the performance of the above indicated work <br />