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Advanced CHAIN OF CUSTODY RECOR[} <br /> _ GeoEn�ironmental, Inc. Date. Page / <br /> of Northern California <br /> ` N <br /> • fU <br /> 1803 Nresi March Lane,Suite A-Stockton,California-95207-(203)9%0264-FaxI <br /> (203}956-0700 A�f�X ifr- <br /> Client slab Project Manager f <br /> jJs'a MA Tests Required f <br /> L' <br /> D. fl4l Phone Number , A <br /> sr.-� A- . 4� or - az` /� /� Ci 3 <br /> Samplers_ (Signature , Invoice: <br /> Project Name �XXpO s 1 d r� �''��`� ��"� �I / � AGE <br /> �t r r tNw Client <br /> Sample Location Sample Type <br /> Number Description Date Time cemWat Grrab- Air Solid Co. Notes 3 <br /> p % <br /> 71AJlC <r �e-� 30 �gaf �-G—F 1�'?S ✓ r <br /> t2:3 ✓ ✓ ✓ ✓ ✓ N ° <br /> inn - x•- x �r <br /> ��rx��rc._`rSry y7,� e fir- _rr 4 s _� <br /> 7Oil, <br /> {�a_ O <br /> e ngmc a Y: rgnatute) i— <br /> r:rr}!� �. x <br /> r tp•(y.9, y: <br /> one <br /> - =;v rA.t <br /> Relln ms e ( �• ^ Datefrime <br /> 4 Y� natre u <br /> ived by: (Signal ) <br /> Da[elTime <br /> Relrnqu is had by: (Signature) <br /> Recetged:hy,Mo iEee La <br /> ignature) DatelFime <br /> • pl N <br /> Dispatched by: (Signature) v laboratory byr —___ Ur <br /> G OC ComoLaboratory <br /> tfJ <br /> dathod of Shipment: <br /> Laboratory Mame <br /> special lrtslruclions: - T CD <br /> N <br /> i Hereby authorize the performance of the above indicated work. <br /> C P ,U' <br />