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ss �� ter esu titititt� � � � � f• � � i♦ <br /> p� Advanced CHAIN OF CUSTODY RECORD <br /> � <br /> GeoEnvironmental, Inc. <br /> Date '° 3 `' page m--. - <br /> _ - Qvt.l DS�Z <br /> 837 Shaw Road- Stockton, California- 95215 -(209)467-1006-Fax (209)467-1118 <br /> Client Project Manager <br /> f Tests Required <br /> q)ri 41 V11\ <br /> Phone Nuffiber <br /> Samplers: (Signature) {i, Invoice: <br /> Project Name ` <br /> �� AGE <br /> d <br /> Popt6y, Client <br /> Sample Location Sample Type <br /> °ate TimeWater Solid No• 'Notes <br /> Number Description comp. arab. Air Conts: <br /> lv <br /> Mw ry 1030 <br /> MW t15-0 <br /> l 0 v <br /> e ngwa y: ig a 11 ece ve y: gnature [^ti{7 -I Dateffime <br /> Relinqui ed by: gnature Recelved by: (Signature) 1 . <br /> _ Daterrlme <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) Dateffime <br /> Dispatched by: (Signature) Date/time Received for Laborato atelTima <br /> Method of Shipment: vOAttM=ALN Labolowry flame <br /> r* <br /> Special tnsttuattons•. ..3.r .., ,'..syLhi CONTAINERS f hereby authorize the performance of the above Indicated work. <br /> ,Z iaWl:iide9lTI-0 IN L AIL-i?RES=VW IN <br />