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CHAIN OF CUSTODY RECORD <br /> 1 ?� Advanced <br /> ®ate ;%2: t;.`� Page of-- ='— " <br /> � <br /> GeoEnvironmental, Inc. <br /> 837 Shaw Road Stockton, California- 95215 -(209)467-1006 - Fax (208) 467-1118 <br /> Client Pr, Project Manager Tests Required <br /> Phone Number <br /> of <br /> Samplers: (Signature _ iO1 ' <br /> AGE ZL <br /> Project Name T"\ t` ClientCl <br /> an <br /> Sample type , <br /> Sample Location Date Time Water Solid No. of / Notes <br /> Description Air Conts. t� <br /> Number }� Comp. Grab. <br /> i��•._ .� tf• t '_r.i� i �-�. 1�! 1r8..? t l �'!.a!r., E., ^. *.+' <br /> Li <br /> } U �if k C� ` <br /> i, Ldt3 ��"-4 .�� ty^'rr l' �� � 'J•'�` x�;.2�;,% (,'� i(4 � � � � .,i � �: <br /> o r , <br /> s ¢¢ Jt 1`9 j}. <br /> ` 1t <br /> � - ��;i .}fad it'`Y ''i �`- �• �. Date/Time <br /> 1 nature ecetYe y: Ignature r ' -g <br /> e ittquYs a y: ( 9 ) <br /> Date(Time <br /> Relinquished by: (S� na re) Received by: (Signature) <br /> Date(Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) <br /> DatelTime Received for Laboratary by: Da ejTime <br /> Dispatched by: (Signature) 1 t .J,� l— <br /> Laboratory Name <br /> Method of Shipment: y� <br /> I hereby authorize the performance of the above indicated work. <br /> Special Instructions: _ <br /> � <br /> i p k f <br />