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4 Advanced i CHAIN OF CUSTODY RECORD"' <br /> GeoEnvironmental Q- / <br /> � Inc. Date c age of� , <br /> of Noaher-rt Calijbi-uirr <br /> 'I 1803 West March Lane,Suite A-Stockton, California-95207-(209)956-0264-Fax(209)956-0700 `Sal 5 <br /> Client `? _ r Project Manager rT O <br /> Tests Required <br /> 17/ <br /> P ne mber <br /> / Samplers: (Signature) Invoice: <br /> ,Project Name �6�,te( LUQ 1" AGE/P< <br /> Client <br /> Sample Location Sample Type a V <br /> Water Solid No. of 1�C <br /> Date Time ,. <br /> Number Description Comp. Grab. Air Conts. / Notes <br /> � .tl <br /> 1'� k <br /> 2;5 d l z <br /> .. <br /> IL <br /> eNgws e ytgnalute ©c v y: (Si - jo 3i_4 r�� Dale/Time <br /> 'Iby: IGIQ y r <br /> Relinquished (Signature) e ' ed by: (Signa re) +�~ 4 r' <br /> Date/Time <br /> . t <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date rime <br /> SDispatched by: (Signature) DatolTime Received for Laboratory by: Dale(Tlme <br /> Method of Shipment: A J <br /> I -`- Labor tory Name <br /> /� RN cei✓c, ��I�dE' � 4w <br /> Special instructions: i hereby authorize the perlormance of the above indicated work. <br /> COME <br /> ICE1r—I PRESERVATIVE <br /> G00D-CON01fta <br /> HEAD SPACEABSNEL CONTNNEHS� <br />