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101111111111 Nov <br /> L Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. t�� V� �, , J,,(, Date r��� �O Page � of <br /> 4005 North Wilson Way-Stockton,Califomla-95205-(209)467-1006-Vax(209)4657-1118 <br /> Client �G Project Manager Tests Ike!� G' fl e q <br /> cared <br /> Phone Number , r 7—Ido( <br /> 00CSamplers: (Signature) l � Invoice: <br /> Project Name r f- _ AGE <br /> U ('-G(qU—�4 Client ❑ <br /> Sample Location Sample Type Solid No. of Notes <br /> Number Description Date Time Water <br /> p Camp. Grab. Air Conis. <br /> W2, - Z X r 993 �fi <br /> �f <br /> VOAS 0& <br /> GOOD 10N IMfaiE <br /> HEAD )-M( tiwowi Cull AN 115--m— <br />! ernuis e ( rgna re} egg+vtr y rgnatur D te[Time <br /> Iry <br /> R r qui he by-yStgn ure) Received try: t gnat ro) <br /> bat ime <br /> Relinquished by: ( ignature) Received by Mobile Laboratory lor lied analysis: (Signature) DatelTime <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Date/Time <br /> Method of Shipment: VO AS G3LiP.L5 OTHLf� Laboratory Name <br /> CL C44 hi <br /> Special Instruimp I hereby a horyize the erlorma ce of the above in Icaled work. <br /> GOOD GONDITIOI'1_ APPPGr`,11KT � � -- <br /> HEAD SPA . <br /> 1I I I'C I <br /> L ;., <br />