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ACIVLlYICBC� CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date 4 zG _ Page of <br /> r of Northern Califo/nia <br /> �,� IBm Weal Mweh twte,Suite A Stockton,Callfomia (xlVj 956-0]b1 <br /> Clientvrporwa Project Manager <br /> groo Tests Required <br /> p.6g�: 46 Phone Number <br /> ZAj 9SZ vs1�Pf- <br /> Samplers; (Signature) Invoice: <br /> Project Name �,��5 /a AGE El <br /> Client fir,' <br /> Sample Location Sample Type of No. i� <br /> Number Description Date Time Water Air Solid Co. Of Notes <br /> Comp. Grab. <br /> s. <br /> K3 -N 3 6' u <br /> '5zo55 <br /> 3 -5 " ,r 4, u <br /> f-Z -u- '5.9 >( 52058 <br /> 12 <br /> Ul-/ 52055 <br /> I. <br /> e is (Signature cat a Dy: tg re Da /Time S <br /> R quished by:. ig � � • "�O <br /> y: (Signet < <br /> _ ate/Time 7 <br /> Co <br /> Re rnquishe b#- (Signature) Recel d by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Date/Time <br /> Method of Shipment: Laboratory Name <br /> Special Instructions: louris !R(1 1MM!PITflBT11 R±T ldJ 6F I hereby auu/thhor�iizzzee the erformence of the above indicated work. <br /> r9Bi <br /> HEADCQ Eltlt'J�r <br /> SPncEA*'BS .j4 cONi aL <br />