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� � i ! � � I• tip � tiles I• tip ti■■i titer ti f• �� tlttfs tff� <br /> Advanced CHAIN .OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date 3-��0-03 Page of <br /> 637 Shaw Road - Stockton, California- 95215- (209) 467-1006 - Fax (209)467-1118 <br /> Client Wedim . L/rc/k. ProjeManager Tests Required <br /> MSA <br /> Phone Number <br /> 46 7 — � 4 <br /> Sam lers; (Signature) �p Invoice: <br /> Project Namef /� <br /> AGE <br /> �JIOG 1 n L..��w V-ck' Client ❑ <br /> Sa a Type <br /> Sample Location Date Time No. Df <br /> Number Description Water Solid Notes <br /> p Comp, Grab. Air Cants, <br /> _iel-nquFshecr inature Received y: gnature DatelTime <br /> alrlik 1160c) <br /> eiinquished by: (Slgnatur Rece ed by: (Signature) bate ime <br /> 4 `' (�&C3 14 <br /> �,TAL3 I 07HER <br /> Ralinquislfift%C0"1VX019APPROPRIt rE K$A9W0U VY M00titfor field analysis:18igneture) DatefTime <br /> HEAD SPACE ABSENT. CA <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by, Dat ime <br /> + i I <br /> Method of Shipment: Laboratory Name <br /> cix ell <br /> Speclal Instructlens: V I hereby authorize the pertorma oe of the above Indicated work. <br />